Effectiveness of Low-dose Intravenous Dexmedetomidine in Preventing Shivering in Total Knee Arthroplasty under Spinal Anesthesia: A Randomized Controlled Trial
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Abstract
BACKGROUND: Shivering is a common complication during anesthesia that causes discomfort, interferes with vital sign monitoring, and increases the risk of perioperative myocardial infarction.
OBJECTIVES: To evaluate the effectiveness of low-dose dexmedetomidine in preventing shivering during spinal anesthesia in elderly patients, and to observe its other side effects.
METHODS: This randomized controlled trial was conducted with 80 patients aged 55–85 years with ASA physical status I-II who underwent total knee arthroplasty under spinal anesthesia. Patients were randomly assigned into two groups of 40 each. The intervention group received 10 micrograms of dexmedetomidine diluted in 10 ml of normal saline, whereas the control group received 10 ml of normal saline at the same infusion rate via the intravenous route. During the operations and in the recovery room, shivering was recorded, vital signs were monitored, and other side effects were observed.
RESULTS: The incidence of shivering in the dexmedetomidine group was seven cases (17.5%), which was lower than that in the control group, with 10 cases (25%), but the difference was not statistically significant (p=0.12). Sedation scores and other side effects also showed no statistically significant differences between the groups.
CONCLUSIONS: Low-dose dexmedetomidine showed a preventive effect on shivering during spinal anesthesia in elderly patients, but the difference was not statistically significant.
Thaiclinicaltrials.org number, TCTR20250712001
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References
Lopez MB. Postanaesthetic shivering - from pathophysiology to prevention. Rom J Anaesth Intensive Care 2018;25:73-81.
Esmat IM, Mohamed MM, Abdelaal WA, El-Hariri HM, Ashoor TM. Postspinal anesthesia shivering in lower abdominal and lower limb surgeries: a randomized controlled comparison between paracetamol and dexamethasone. BMC Anesthesiol [Internet]. 2021 [cited 2025 Aug 5];21(1):262. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC8556952/pdf/12871_2021_Article_1483.pdf
Xu R, Hu X, Sun Z, Zhu X, Tang Y. Incidence of postoperative hypothermia and shivering and risk factors in patients undergoing malignant tumor surgery: a retrospective study. BMC Anesthesiol [Internet]. 2023 [cited 2025 Aug 5];23(1):31. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC9869522/pdf/12871_2023_Article_1991.pdf
Mohammed S, Biyani G, Kalagara R, Kumar M, Baidya DK, Chhabra S, et al. Role of intravenous dexmedetomidine in the prevention and treatment of shivering in pregnant patients undergoing cesarean section under central neuraxial blockade: a systematic review and meta-analysis. Journal of Obstetric Anaesthesia and Critical Care 2024;14:5-6.
Reel B, Maani CV. Dexmedetomidine [Internet]. 2023 [cited 2025 Sep 12]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK513303/
Baxter. Dexmedetomidine hydrochloride for injection, USP product monograph [Internet]. 2022 [cited 2025 Sep 12]. Available from: https://www.baxter.ca/sites/g/files/ebysai1431/files/2023-01/ca-m131-Dexmed-eng.pdf
Wang J, Wang Z, Liu J, Wang N. Intravenous dexmedetomidine versus tramadol for treatment of shivering after spinal anesthesia: a meta-analysis of randomized controlled trials. BMC Anesthesiol [Internet]. 2020 [cited 2025 Aug 4];20(1):104. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC7199340/pdf/12871_2020_Article_1020.pdf
Li YZ, Jiang Y, Lin H, Yang XP. Subarachnoid and epidural dexmedetomidine for the prevention of post-anesthetic shivering: a meta-analysis and systematic review. Drug Des Devel Ther 2019;13:3785-98.
Sween LK, Xu S, Li C, O'Donoghue MA, Ciampa EJ, Kowalczyk JJ, et al. Low-dose intravenous dexmedetomidine reduces shivering following cesarean delivery: a randomized controlled trial. Int J Obstet Anesth 2021;45:49-55.
Tunprasit C, Dusitkasem S, Khakhuy C, Limpoon S. Efficacy of post intubation dexmedetomidine infusion for prevention of postoperative shivering. Thai Journal of Anesthesiology 2016;42:139-48.
Omar H, Aboella WA, Hassan MM, Hassan A, Hassan P, Elshall A, et al. Comparative study between intrathecal dexmedetomidine and intrathecal magnesium sulfate for the prevention of post-spinal anaesthesia shivering in uroscopic surgery; (RCT). BMC Anesthesiol [Internet]. 2019 [cited 2025 Sep 25];19(1):190. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC6814123/pdf/12871_2019_Article_853.pdf
Pang G, Zhu Y, Zhou Y, Tong S. The anesthetic effect and safety of dexmedetomidine in cesarean section: a meta-analysis. Biomed Res Int [Internet]. 2022 [cited 2025 Jan 10];2022:1681803. Available from: https://onlinelibrary.wiley.com/doi/10.1155/2022/1681803
Cho SA, Yoon S, Lee SJ, Jee YS, Cho CK, Sung TY. Clinical efficacy of short-term prewarming in elderly and adult patients: A prospective observational study. Int J Med Sci 2022;19:1548-56.
