Safety and efficacy of dexmedetomidine in treating post spinal anesthesia shivering: A randomized clinically controlled dose-finding trial

Background: the optimum dose of dexmedetomidine for shivering control with the least hemodynamic derangements is still under research. objective: to compare the efficacy,hemodynamic and side effects of dexmedetomidine in 3 different doses with those of meperidine for the treatment of shivering in patients undergoing spinal anesthesia for minor elective lower abdominal surgery. study design: prospective double-blind randomized clinically controlled study. setting: university hospital. methods: one hundred twenty patients who developed shivering under spinal anesthesia. on shivering,patients were randomly allocated to receive an intravenous 2 ml bolus dose of meperidine 0.4 mg/kg (meperidine group,n = 30),dexmedetomidine 0.5 µg/kg (dex i group,n = 30),0.3 µg/kg (dex ii group,n = 30),or 0.2µg/kg (dex iii group,n = 30). control of shivering,time taken for cessation of shivering,response rate,recurrence,hemodynamic changes,sedation score,tympanic temperature,and side effects were noted and compared between groups. results: the groups were comparable regarding demographic profile,tympanic temperature decline,and shivering onset time (p > 0.05). lower shivering cessation time (p < 0.001) and higher response rate (p < 0.01) were observed in dex i and ii groups compared with dex iii and meperidine groups,with a nonsignificant difference between dex i and ii groups. recurrence of shivering activity was higher in dex iii group (36.7%,p < 0.01) compared with dex i (10%),dex ii (6.7%) and meperidine (16.7%) groups. lower heart rates,systolic and diastolic blood pressure mean values were recorded in dex i group (p < 0.05). nine patients (30%) in dex i group were in levels 3 – 5 of sedation (p < 0.02) compared with 5 (16.66%),2 (6.66%),and 4 (13.3) patients in dex ii,dex iii,and meperidine groups,respectively. limitations: this study is limited by its small sample size. conclusions: among the 3 doses investigated,dexmedetomidine 0.3µg/kg effectively treated shivering associated with spinal anesthesia with modest hemodynamic and sedation effects. © 2016,american society of interventional pain physicians. all rights reserved.