Rania Maher Hussien Associate professor- Ain Shams University Osama Medhat Ragab Abdelrehem, Dr Resident of Anesthesia, Intensive Care and Pain Management Faculty of Medicine, Ain Shams University, Cairo, Egypt https://orcid.org/0009-0004-0978-6545 Yassmin Hassan Abd El Sattar Lecturer of anesthesia, Intensive Care, and Pain Management department Faculty of Medicine, Ain Shams University, Cairo, Egypt Rami Mounir Wahba Gobrane Assistant Professor of anesthesia, Intensive Care, and Pain Management department Faculty of Medicine, Ain Shams University, Cairo, Egypt

Keywords: Dexmedetomidine, Fentanyl, Intrathecal Bupivacaine, Post Spinal Shivering, Cesarean Section

Abstract

Background & objective: Shivering is one of the common troublesome complications following regional anesthesia, which causes much discomfort to the patient, besides its adverse effects on the oxygenation and hemodynamic parameters. It may interfere with pulse oximetry and electrocardiogram monitoring. It can also increase oxygen demand. Various pharmacological and non-pharmacological measures have been used to prevent and/or control shivering. We conducted this study to observe if addition of dexmedetomidine to the spinal bupivacaine for cesarean section will offer better results as compared to fentanyl added to bupivacaine.

Methodology: 130 parturients, scheduled to have spinal anesthesia for cesarean section, were divided into two equal groups; each consisting of 65 patients. Fentanyl group: received 25 µg fentanyl with 12.5 mg hyperbaric bupivacaine 0.5% intrathecally, and Dexmedetomidine group: received 10 μg dexmedetomidine with 12.5 mg hyperbaric bupivacaine 0. 5% intrathecally. The frequency and the intensity of shivering was registered. The time to onset and duration of the sensory as well as motor blocks was noted. Hemodynamic parameters were compared.

Results: Post-spinal shivering was more apparent in the fentanyl group; however, there was no statistical difference between both groups regarding its incidence and intensity. Patients in the dexmedetomidine group had a faster onset and a longer duration of both sensory and motor block compared to the fentanyl group patients. Therefore, time to first rescue analgesic was longer in the dexmedetomidine group. Regarding the hemodynamic parameters dexmedetomidine group showed no statistically significant difference regarding hypotension and a statistically significant difference regarding occurrence of bradycardia compared to fentanyl group.

Conclusion: Both fentanyl and dexmedetomidine, as intrathecal adjuvants to bupivacaine decreased the incidence and the intensity of shivering without any significant difference.

Keywords: Dexmedetomidine; Fentanyl; Intrathecal Bupivacaine; Post Spinal Shivering; Cesarean Section

Citation: Hussien RM, Abdelrehem OMR, Abd El Sattar YH, Gobrane RMW. Efficacy of dexmedetomidine versus fentanyl as adjuvant to intrathecal bupivacaine in decreasing incidence of post spinal shivering in parturients undergoing cesarean section. Anaesth. pain intensive care 2025;29(4):301-7. DOI: 10.35975/apic.v29i4.2600

Received: May 09, 2024; Revised: October 26, 2024; Accepted: January 01, 2025