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Prophylactic effects of intrathecal Meperidine and intravenous Ondansetron on shivering in patients undergoing lower extremity orthopedic surgery under spinal anesthesia.

Safavi M, Honarmand A, Negahban M, Attari M - J Res Pharm Pract (2014)

Bottom Line: There was a significant difference between Group O and M compared to Group C (P = 0.023 for Group O vs.Shivering incidence and intensity in Group M was significantly lower than Group O (P = 0.049 and P = 0.047, respectively).We concluded that IT meperidine and IV ondansetron comparably can decrease intensity and incidence of shivering compared to control group as well as decreasing the requirement to additional doses of meperidine for shivering the control without any hemodynamic side effect.

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesia and Intensive Care Medicine, Anesthesiology and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.

ABSTRACT

Objective: Intraoperative hypothermia is a common problem with anesthesia. Spinal anesthesia, the same as general anesthesia, affects the process of temperature regulation. The aim of this study was to compare the prophylactic effect of intravenous (IV) ondansetron with intrathecal (IT) meperidine on prevention of shivering during spinal anesthesia in patients underwent orthopedic surgery of the lower limb.

Methods: In this study, 120 patients with American Society of Anesthesiologists physical status I to II, between the ages 16 and 65 were randomized into three groups. Group O and Group M were given IV ondansetron 8 mg and IT meperidine 0.2 mg/kg, before spinal anesthesia, respectively. Group C received IV saline 0.9%. The core and ambient temperatures, the incidence and intensity of shivering, blood pressure, heart rate, and maximum level of sensory block were recorded.

Findings: Shivering was observed in 15%, 2.5%, and 37.5% of patients in Groups O, M, and C, respectively. There was a significant difference between Group O and M compared to Group C (P = 0.023 for Group O vs. Group C, P < 0.001 for Group M vs. Group C, P = 0.049 for Group M vs. Group O). Shivering incidence and intensity in Group M was significantly lower than Group O (P = 0.049 and P = 0.047, respectively). Twenty-two patients required additional IV meperidine among which 15 patients were from Group C (37.5%), six patients from Group O (15%) and one patient from Group M (2.5%).

Conclusion: We concluded that IT meperidine and IV ondansetron comparably can decrease intensity and incidence of shivering compared to control group as well as decreasing the requirement to additional doses of meperidine for shivering the control without any hemodynamic side effect.

No MeSH data available.


Related in: MedlinePlus

CONSORT diagram of the study
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Figure 1: CONSORT diagram of the study

Mentions: The present study was performed on 120 patients. Related flow diagram is shown in Figure 1. Demographic data, surgery duration, type of surgery, and maximum level of sensory blockade are given in Table 1. Data of all variables were normally distributed according to the results of Shapiro-Wilk test. This table shows there were no significant differences between groups (P > 0.05). The mean core and skin temperatures were measured before and during spinal anesthesia and are shown in Table 2. There were not observed any significant difference between groups in this regard (P > 0.05). Systolic, diastolic, and mean arterial pressures, and heart rate were somehow similar in all groups with no significant difference (P > 0.05). Oxygen saturation percentage for no patient was lower than 90% during the study, and no clear difference was observed between groups. Intensity and incidence of shivering are shown in Table 3. The incidence of shivering was significantly lower in Group O compared to Group C (P = 0.023). Shivering incidence in Group M was significantly lower compared to the control group (P < 0.001). Shivering incidence in Group M was lower than Group O with a clear statistical difference (P = 0.049). Shivering intensity in Groups O and M were significantly lower than Group C (P = 0.016 and P < 0.001, respectively). Shivering intensity in Group M was lower than Group O, and there was a clear statistical difference in this regard (P = 0.047). In the present study, 15 patients required ephedrine for hypotension among which nine patients were from Group C (22.5%), three patients from Group O (7.5%) and three patients from Group M (7.5%) and no significant difference was observed between groups (P > 0.05). Bradycardia was observed in three patients from Group C and O and was not seen in Group M. In these three patients, it was treated by atropine (2.5% in one patient from Group C and 5% in two patients from Group O). There was a significant difference between Groups O and C regarding the administration of atropine (P < 0.001). Nausea, vomiting, and itching were not seen in any patient. Twenty-two patients required additional IV meperidine among which 15 patients were from Group C (37.5%), six patients from Group O (15%), and one patient from Group M (2.5%) [Table 1]. There was a significant difference between Groups O and M with Group C (P < 0.001 for Group O vs. Group C; P < 0.001 for Group M vs. Group C), while no significant differences were seen between Group M and Group O regarding administering the additional meperidine (P = 0.061).


Prophylactic effects of intrathecal Meperidine and intravenous Ondansetron on shivering in patients undergoing lower extremity orthopedic surgery under spinal anesthesia.

Safavi M, Honarmand A, Negahban M, Attari M - J Res Pharm Pract (2014)

CONSORT diagram of the study
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4199198&req=5

Figure 1: CONSORT diagram of the study
Mentions: The present study was performed on 120 patients. Related flow diagram is shown in Figure 1. Demographic data, surgery duration, type of surgery, and maximum level of sensory blockade are given in Table 1. Data of all variables were normally distributed according to the results of Shapiro-Wilk test. This table shows there were no significant differences between groups (P > 0.05). The mean core and skin temperatures were measured before and during spinal anesthesia and are shown in Table 2. There were not observed any significant difference between groups in this regard (P > 0.05). Systolic, diastolic, and mean arterial pressures, and heart rate were somehow similar in all groups with no significant difference (P > 0.05). Oxygen saturation percentage for no patient was lower than 90% during the study, and no clear difference was observed between groups. Intensity and incidence of shivering are shown in Table 3. The incidence of shivering was significantly lower in Group O compared to Group C (P = 0.023). Shivering incidence in Group M was significantly lower compared to the control group (P < 0.001). Shivering incidence in Group M was lower than Group O with a clear statistical difference (P = 0.049). Shivering intensity in Groups O and M were significantly lower than Group C (P = 0.016 and P < 0.001, respectively). Shivering intensity in Group M was lower than Group O, and there was a clear statistical difference in this regard (P = 0.047). In the present study, 15 patients required ephedrine for hypotension among which nine patients were from Group C (22.5%), three patients from Group O (7.5%) and three patients from Group M (7.5%) and no significant difference was observed between groups (P > 0.05). Bradycardia was observed in three patients from Group C and O and was not seen in Group M. In these three patients, it was treated by atropine (2.5% in one patient from Group C and 5% in two patients from Group O). There was a significant difference between Groups O and C regarding the administration of atropine (P < 0.001). Nausea, vomiting, and itching were not seen in any patient. Twenty-two patients required additional IV meperidine among which 15 patients were from Group C (37.5%), six patients from Group O (15%), and one patient from Group M (2.5%) [Table 1]. There was a significant difference between Groups O and M with Group C (P < 0.001 for Group O vs. Group C; P < 0.001 for Group M vs. Group C), while no significant differences were seen between Group M and Group O regarding administering the additional meperidine (P = 0.061).

Bottom Line: There was a significant difference between Group O and M compared to Group C (P = 0.023 for Group O vs.Shivering incidence and intensity in Group M was significantly lower than Group O (P = 0.049 and P = 0.047, respectively).We concluded that IT meperidine and IV ondansetron comparably can decrease intensity and incidence of shivering compared to control group as well as decreasing the requirement to additional doses of meperidine for shivering the control without any hemodynamic side effect.

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesia and Intensive Care Medicine, Anesthesiology and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.

ABSTRACT

Objective: Intraoperative hypothermia is a common problem with anesthesia. Spinal anesthesia, the same as general anesthesia, affects the process of temperature regulation. The aim of this study was to compare the prophylactic effect of intravenous (IV) ondansetron with intrathecal (IT) meperidine on prevention of shivering during spinal anesthesia in patients underwent orthopedic surgery of the lower limb.

Methods: In this study, 120 patients with American Society of Anesthesiologists physical status I to II, between the ages 16 and 65 were randomized into three groups. Group O and Group M were given IV ondansetron 8 mg and IT meperidine 0.2 mg/kg, before spinal anesthesia, respectively. Group C received IV saline 0.9%. The core and ambient temperatures, the incidence and intensity of shivering, blood pressure, heart rate, and maximum level of sensory block were recorded.

Findings: Shivering was observed in 15%, 2.5%, and 37.5% of patients in Groups O, M, and C, respectively. There was a significant difference between Group O and M compared to Group C (P = 0.023 for Group O vs. Group C, P < 0.001 for Group M vs. Group C, P = 0.049 for Group M vs. Group O). Shivering incidence and intensity in Group M was significantly lower than Group O (P = 0.049 and P = 0.047, respectively). Twenty-two patients required additional IV meperidine among which 15 patients were from Group C (37.5%), six patients from Group O (15%) and one patient from Group M (2.5%).

Conclusion: We concluded that IT meperidine and IV ondansetron comparably can decrease intensity and incidence of shivering compared to control group as well as decreasing the requirement to additional doses of meperidine for shivering the control without any hemodynamic side effect.

No MeSH data available.


Related in: MedlinePlus