COMPARATIVE STUDY BETWEEN INTRATHECAL DEXMEDETOMIDINE AND DEXAMETHASONE AS ADJUVANTS TO BUPIVACAINE FOR PREVENTION OF PERIOPERATIVE SHIVERING IN CAESAREAN SECTION
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Keywords
Dexmedetomidine, Dexamethasone, Spinal anaesthesia, Shivering, Caesarean section
Abstract
Background and aims: Perioperative shivering after spinal anaesthesia is common in caesarean section and increases oxygen consumption, carbon dioxide production and cardiac work load. Dexmedetomidine and dexamethasone are increasingly used intrathecally as adjuvants and may influence shivering, sedation and block characteristics. This study compared intrathecal dexmedetomidine and dexamethasone added to hyperbaric bupivacaine for prevention of shivering.
Methods: In this prospective, randomised, blind controlled trial, 60 ASA II parturients undergoing caesarean section under spinal anaesthesia were allocated to receive either dexmedetomidine 10 µg (Group D) or dexamethasone 4 mg (Group C) with 12.5 mg 0.5% hyperbaric bupivacaine. Shivering (Bedside Shivering Assessment Scale, Crossley-Mahajan scale), Ramsay sedation scores, Hemo dynamics, SpO₂, motor block duration and adverse events were recorded at predefined intervals.
Results: Demographic profile and surgery duration were comparable. Mean Ramsay score was higher with dexmedetomidine (3.5) than with dexamethasone (2.0, P < 0.0001). Shivering incidence and severity were low and similar in both groups at all time points. Heart rate, blood pressure and SpO₂ remained stable and comparable. Motor block duration was longer with dexamethasone (180.33 min) than with dexmedetomidine (161.33 min). Adverse events were infrequent and did not differ significantly (P = 0.33). Conclusion: Intrathecal dexmedetomidine 10 µg and dexamethasone 4 mg, as adjuvants to bupivacaine for caesarean section, are equally effective for shivering prophylaxis with good haemodynamic stability. Dexmedetomidine provides greater sedation, whereas dexamethasone prolongs motor block and may enhance postoperative analgesia.
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Dr Sukriti Atram
Associate Professor, Department of Anaesthesiology, Grant Government Medical College, Mumbai, India
Dr Dnyaneshwar Raosaheb Thombre
Clinical Assistant in Critical Care, P. D. Hinduja Hospital, Mumbai, India
Dr Manoj B
Senior Resident, Department of Anaesthesiology, Grant Government Medical College, Mumbai, India
