Comparison of the Efficacy of Intravenous Paracetamol and Ondansetron for Prevention of Post-spinal Anesthesia Shivering Following Lower Abdominal and Lower Limb Surgeries in Buddhasothorn Hospital: A Phase II Prospective, Double-blind, Randomized Controlled Trial
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Abstract
Background: Post-spinal anesthesia shivering is a common complication. Severe shivering can significantly increase oxygen consumption and cardiac workload, posing risks to patients with cardiovascular vulnerabilities. Prophylactic administration of anti-shivering agents has been shown to be more effective than symptomatic treatment after the onset of shivering.
Objective: To compare the efficacy of intravenous paracetamol and ondansetron in preventing the incidence of shivering following spinal anesthesia in patients undergoing lower abdominal and lower extremity surgeries.
Methods: This randomized, double-blind clinical trial included 60 patients, divided into two groups of 30. Group P received intravenous paracetamol at a dose of 15 mg/kg or 1,000 mg for patients weighing over 50 kg, while Group O received 8 mg of intravenous ondansetron. Data were collected on the incidence and severity of shivering, body temperature, hemodynamic side effects, and the occurrence of nausea and vomiting both intraoperative and in the post-anesthesia care unit (PACU). Statistical analysis was performed using SPSS version 29.0.1.
Results: The intraoperative incidence of shivering in the paracetamol group and the ondansetron group was 20.0% and 13.3% (p-value=0.729), which was not statistically significant. Similarly, the incidence in the PACU was 6.7% in Group P and 3.3% in Group O (p-value=1.000). No significant differences were found in the severity of shivering between the two groups. However, a statistically significant difference was observed in the incidence of hypotension; the paracetamol group experienced hypotension at a rate of 36.7%, compared to only 10.0% in the ondansetron group (p-value=0.015)
Conclusion: Intravenous paracetamol and ondansetron are equally effective in preventing post-spinal anesthesia shivering. However, the paracetamol group exhibited a significantly higher incidence of intraoperative hypotension, despite limitations in establishing a temporal relationship.
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