Intravenous magnesium sulfate versus intravenous meperidine to prevent shivering during spinal anesthesia
BACKGROUND Shivering is a frequent event during neuraxial anesthesia due to impaired central and peripheral thermoregulation control. Meperidine and MgSO4 are effective in lowering the shivering threshold. Hence, this study aimed to compare the efficacy of MgSO4 and meperidine to prevent shivering in patients undergoing spinal anesthesia.
METHODS This was a double-blind randomized clinical trial of 100 patients divided into 2 groups. One group had MgSO4 30 mg/kg, and the other group had meperidine 0.5 mg/kg intravenously in 100 ml of 0.9% NaCl before undergoing spinal anesthesia. Participants were non-pregnant patients aged 18–65 years and had physical status I or II (based on the American Society of Anesthesiologist). Shivering was considered significant if it occurred in grade 3 or 4. Patient characteristics, shivering degree, tympanic membrane temperature, and side effects were recorded.
RESULTS Shivering occurred 10% in the MgSO4 group and 19% in the meperidine group, with p = 0.23. Both groups had similar side effects of nausea, vomiting, and hypotension.
CONCLUSIONS MgSO4 30 mg/kg was not superior to meperidine 0.5 mg/kg intravenously in preventing shivering in patients undergoing spinal anesthesia.
Kim YA, Kweon TD, Kim M, Lee HI, Lee YJ, Lee KY. Comparison of meperidine and nefopam for prevention of shivering during spinal anesthesia. Korean J Anesthesiol. 2013;64(3):229-33. https://doi.org/10.4097/kjae.2013.64.3.229
Elsonbaty M, Elsonbaty A, Saad D. Is this the time for magnesium sulfate to replace meperidine as an antishivering agent in spinal anesthesia? Egypt J Anaesth. 2013;29(3):213-7. https://doi.org/10.1016/j.egja.2013.03.002
Ibrahim IT, Megalla SA, Khalifa OShM, salah El Deen HM. Prophylactic vs. therapeutic magnesium sulfate for shivering during spinal anesthesia. Egypt J Anaesth. 2014;30(1):31-7. https://doi.org/10.1016/j.egja.2013.07.007
Shin HJ, Do SH. Magnesium sulfate: a versatile anesthetic adjuvant. J Anest & Inten Care Med. 2017;4(5):555646. https://doi.org/10.19080/JAICM.2017.04.555646
Destaw B, Melese E, Jemal S. Effects of prophylactic intravenous dexamethasone versus pethidine for prevention of post-spinal anesthesia shivering for patients who underwent transurethral resection of the prostate under spinal anesthesia: prospective cohort study. Int J Surg Open. 2020;26:137-44. https://doi.org/10.1016/j.ijso.2020.08.015
Sachidananda R, Basavaraj K, Shaikh SI, Umesh G, Bhat T, Arpitha B. Comparison of prophylactic intravenous magnesium sulfate with tramadol for postspinal shivering in elective cesarean section: a placebo controlled randomized double-blind pilot study. Anesth Essays Res. 2018;12(1):130-4. https://doi.org/10.4103/aer.AER_196_17
Lopez MB. Postanaesthetic shivering - from pathophysiology to prevention. Rom J Anaesth Intensive Care. 2018;25(1):73-81. https://doi.org/10.21454/rjaic.7518.251.xum
Nasiri A, Akbari A, Sharifzade G, Derakhshan P. The effects of warmed intravenous fluids, combined warming (warmed intravenous fluids with humid-warm oxygen), and pethidine on the severity of shivering in general anesthesia patients in the recovery room. Iran J Nurs Midwifery Res. 2015;20(6):712-6. https://doi.org/10.4103/1735-9066.170014
Mesbah Kiaee M, Safari S, Movaseghi GR, Mohaghegh Dolatabadi MR, Ghorbanlo M, Etemadi M, et al. The effect of intravenous magnesium sulfate and lidocaine in hemodynamic responses to endotracheal intubation in elective coronary artery bypass grafting: a randomized controlled clinical trial. Anesth Pain Med. 2014;4(3):e15905. https://doi.org/10.5812/aapm.15905
Kizilirmak S, Karakaş SE, Akça O, Ozkan T, Yavru A, Pembeci K, et al. Magnesium sulfate stops postanesthetic shivering. Ann N Y Acad Sci. 1997;813:799-806. https://doi.org/10.1111/j.1749-6632.1997.tb51784.x
T M, Kaparti L. A randomised trial comparing efficacy, onset and duration of action of pethidine and tramadol in abolition of shivering in the intra operative period. J Clin Diagn Res. 2014;8(11):GC07-9.
Sessler DI. Perioperative thermoregulation and heat balance. Lancet. 2016;387(10038):2655-64. https://doi.org/10.1016/S0140-6736(15)00981-2
de Brito Poveda V, Galvão CM, dos Santos CB. Factors associated to the development of hypothermia in the intraoperative period. Rev Lat Am Enfermagem. 2009;17(2):228-33. https://doi.org/10.1590/S0104-11692009000200014
Zweifler RM, Voorhees ME, Mahmood MA, Parnell M. Magnesium sulfate increases the rate of hypothermia via surface cooling and improves comfort. Stroke. 2004;35(10):2331-4. https://doi.org/10.1161/01.STR.0000141161.63181.f1
Kurz A, Ikeda T, Sessler DI, Larson MD, Bjorksten AR, Dechert M, et al. Meperidine decreases the shivering threshold twice as much as the vasoconstriction threshold. Anesthesiology. 1997;86(5):1046-54. https://doi.org/10.1097/00000542-199705000-00007
Wadhwa A, Sengupta P, Durrani J, Akça O, Lenhardt R, Sessler DI, et al. Magnesium sulfate only slightly reduces the shivering threshold in humans. Br J Anaesth. 2005;94(6):756-62. https://doi.org/10.1093/bja/aei105
De Witte J, Sessler DI. Perioperative shivering: physiology and pharmacology. Anesthesiology. 2002;96(2):467-84. https://doi.org/10.1097/00000542-200202000-00036
Lin Y, Zhou C, Liu Z, Wu K, Chen S, Wang W, et al. Room temperature versus warm irrigation fluid used for patients undergoing arthroscopic shoulder surgery: a systematic review and meta analysis. J Perianesth Nurs. 2020;35(1):48-53. https://doi.org/10.1016/j.jopan.2019.06.006
Singh R, Asthana V, Sharma JP, Lal S. Effect of irrigation fluid temperature on core temperature and hemodynamic changes in transurethral resection of prostate under spinal anesthesia. Anesth Essays Res. 2014;8(2):209-15. https://doi.org/10.4103/0259-1162.134508
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