The Efficacy of Dexamethasone in Reducing Postoperative Shivering after Caesarean Section Under Spinal Anesthesia: A Randomized Controlled Trial
DOI:
https://doi.org/10.55674/ajhe.v3i1.3563Keywords:
Dexamethasone, Cesarean section, Spinal anesthesia, Postoperative shiveringAbstract
This randomized, triple-blind controlled trial aimed to evaluate the efficacy of prophylactic dexamethasone 0.15 mg/kg in preventing postoperative shivering in 186-term pregnant women scheduled for cesarean section under spinal anesthesia. Participants were computer-randomized with concealed allocation. The treatment group received dexamethasone 0.15 mg/kg diluted to 10 ml while the control group received normal saline 10 ml, both administered by blinded anesthesia nurses. Data were analyzed using repeated measures ANOVA for temperature changes and Fisher's exact test for shivering incidence.
The results showed that dexamethasone significantly reduced the incidence of postoperative shivering (12.90% vs 27.96%, p = 0.010), with a relative risk reduction of 53.85% and the number needed to treat 7. The dexamethasone group maintained significantly higher core temperatures (mean difference 0.376°C, p < 0.001) and required less rescue pethidine (3.23% vs 16.13%, p = 0.005). Both groups showed similarly low rates of postoperative nausea and vomiting (1.08% vs 2.15%, p = 0.50), and no surgical site infections were observed during the follow-up period. These findings suggest that prophylactic dexamethasone 0.15 mg/kg effectively reduces postoperative shivering in cesarean section under spinal anesthesia with a favorable safety profile. This intervention could be considered for incorporation into routine care protocols for eligible patients.
References
(1) De Witte J, Sessler DI. Perioperative shivering: physiology and pharmacology. The Journal of the American Society of Anesthesiologists. 2002; 96 (2): 467 - 84.
(2) Lopez MB. Postanaesthetic shivering–from pathophysiology to prevention. Romanian journal of anesthesia and intensive care. 2018; 25 (1): 73 - 81.
(3) Crowley LJ, Buggy DJ. Shivering and neuraxial anesthesia. Regional Anesthesia & Pain Medicine. 2008; 33 (3): 241 - 52.
(4) Liu J, Wang Y, Ma W. Shivering prevention and treatment during cesarean delivery under neuraxial anesthesia: a systematic review. Minerva anestesiologica. 2018; 84 (12): 1393 - 405.
(5) Buggy D, Crossley A. Thermoregulation, mild perioperative hypothermia and post-anaesthetic shivering. British journal of anaesthesia. 2000; 84 (5): 615 - 28.
(6) Paulick RP, Meyers RL, Rudolph AM. Effect of maternal oxygen administration on fetal oxygenation during graded reduction of umbilical or uterine blood flow in fetal sheep. Am J Obstet Gynecol. 1992; 167 (1): 233 - 9.
(7) Matsota PK, Koliantzaki IK, Kostopanagiotou GG. Pharmacological approach for the prevention of postoperative shivering: a systematic review of prospective randomized controlled trials. Asian Journal of Anesthesiology. 2019; 57 (3): 66 - 84.
(8) Ullian ME. The role of corticosteroids in the regulation of vascular tone. Cardiovascular Research. 1999; 41 (1): 55 - 64.
(9) Ituk U, Thenuwara K. The effect of a single intraoperative dose of intravenous dexamethasone 8 mg on post-cesarean delivery analgesia: a randomized controlled trial. International journal of obstetric anesthesia. 2018; 35: 57 - 63.
(10) Entezariasl M, Isazadehfar K. Dexamethasone for prevention of postoperative shivering: a randomized double-blind comparison with pethidine. International journal of preventive medicine. 2013; 4 (7): 818.
(11) Arunee Saengsanon, Saran Sriwasutha, Sukhumakorn Worathongchai. The effect of dexamethasone in decrease postoperative shivering after caesarean delivery under spinal anesthesia: A randomized, double-blinded, placebo-controlled study. Thammasat Medical Journal. 2016; 16 (3): 388 - 95.
(12) Khosravi AR, Moinvaziri MT, Esmaili MH, Farbood A, Nik-khoo H, Yarmohammadi H. Treatment of Postoperative Shivering with Dexamethasone: A Prospective Randomized Clinical Trial. Iranian Journal of Medical Sciences. 2015; 27: 15 - 7.
(13) Crossley A, Mahajan R. The intensity of postoperative shivering is unrelated to axillary temperature. Anesthesia. 1994; 49 (3): 205 - 7.
(14) McMurray RG, Katz VL. Thermoregulation in pregnancy. Implications for exercise. Sports Med. 1990; 10 (3): 146 - 58.
(15) De Oliveira GS, Jr., Castro-Alves LJ, Ahmad S, Kendall MC, McCarthy RJ. Dexamethasone to prevent postoperative nausea and vomiting: an updated meta-analysis of randomized controlled trials. Anesth Analg. 2013; 116 (1): 58 - 74.
(16) Abebe M, Alemu B, Teku G, Eshetu O, Wale E, Besha A, et al. Effectiveness of Single Intravenous Dexamethasone in Prolongation of Spinal Anesthesia for Postoperative Analgesia in Elective Cesarean Section: A Systematic Review of Randomized Controlled Trials. J Pain Res. 2024; 17: 1361 - 8.
(17) Tu Q, Zhou R, Wan Z, Chen S, Yang Q, Que B. Perioperative administration of dexamethasone to prevent postoperative shivering: a systematic review and meta-analysis of randomized controlled trials. J Int Med Res. 2023; 51 (8): 3000605231187805.
