การเปรียบเทียบอุบัติการณ์ภาวะหนาวสั่นระหว่างการใช้ยา Parecoxib ร่วมกับ Ondansetron และการใช้ยาเดี่ยวในผู้ป่วยที่ได้รับการผ่าตัดคลอดด้วยวิธีการให้ยาระงับความรู้สึกแบบทั่วร่างกาย

Aekvitoon  Boonsiripiyachok

Authors

Aekvitoon Boonsiripiyachok M.D., Thong Pha Phum Hospital

Keywords:

ondansetron, parecoxib, shivering, shivering score, synergistic effect

Abstract

Objective: Postoperative shivering is a common and distressing complication, especially in pregnant women undergoing cesarean sections. This condition can significantly increase the body’s metabolic rate, raising oxygen demand by 500–600%. Such a rise can be life-threatening for patients with pre-existing heart or lung conditions. This study aims to compare the incidence of shivering in cesarean section patients under general anesthesia after receiving a combination of parecoxib and ondansetron (OP) versus receiving parecoxib (P) or ondansetron (O) alone.

Methods: This prospective randomized controlled trial was conducted at Thongphaphum Hospital and Somdet Phra Sangkharaja 19 Hospital from May to December 2024. A total of 278 patients were randomized into three groups. The research instruments included an infrared thermometer, the Bedside Shivering Assessment Scale (BSAS), and the Numeric Rating Scale (NRS). Data were analyzed using one-way ANOVA and binary logistic regression.

Results: The overall incidence of shivering in all 277 patients was 9.03%. The highest incidence was in the P group (13.3%), followed by the O group (10.6%), and the lowest in the OP group (3.2%). The difference in shivering incidence between the P and OP groups was statistically significant (p-value = .021), with the P group having 4.62 times higher odds of shivering. No significant difference was found between the O and OP groups (p-value = .060), although the O group had 3.57 times higher odds of shivering than the OP group.

Conclusion: The combination of parecoxib and ondansetron significantly reduced the incidence of shivering compared to either drug alone. This suggests a synergistic effect where the drugs' different mechanisms—the serotonergic pathway for ondansetron and the prostaglandin pathway for parecoxib—provide a more comprehensive prevention of shivering. The combined therapy is an effective and safe alternative for preventing postoperative shivering.

References

Matsota PK, Koliantzaki IK, Kostopanagiotou GG. Pharmacological approach for the prevention of postoperative shivering: A systematic review of prospective randomized controlled trials. Asian J Anesthesiol. 2019;57(3):66–84. doi: 10.6859/aja.201909_57(3).0002.

Alkhaled L, Almashouj A, Rekmani N. A study of the incidence of shivering after cesarean section surgery, a comparative study between general and spinal anesthesia. ResearchGate. 2024:1–17. doi: 10.21203/rs.3.rs-3890872/v1

Tie HT, Su GZ, He K, Liang SR, Yuan HW, Mou JH. Efficacy and safety of ondansetron in preventing postanesthesia shivering: a meta-analysis of randomized controlled trials. BMC Anesthesiol. 2014;14:12. doi: 10.1186/1471-2253-14-12.

Zhu Y, Zhou C, Yang Y, Chen Y. Efficacy of parecoxib sodium on postoperative shivering: meta-analysis of clinical trials. J Int Med Res. 2018;46(1):3–10. doi: 10.1177/0300060517717359.

Chatproedprai S, Heamawatanachai K, Tempark T, Wananukul S. A comparative study of 3 different methods of temperature measurement in children. J Med Assoc Thai. 2016;99(2):142–9.

Apa H, Gözmen S, Bayram N, Çatkoğlu A, Devrim F, Karaarslan U, et al. Clinical accuracy of tympanic thermometer and noncontact infrared skin thermometer in pediatric practice: an alternative for axillary digital thermometer. Pediatr Emerg Care. 2013;29(9):992–7. doi: 10.1097/PEC.0b013e3182a2d419.

Kim MS, Kim DW, Woo SH, Jun HY, Lee S. Effects of ramosetron on shivering during spinal anesthesia. Korean J Anesthesiol. 2010;58(3):256–9. doi: 10.4097/kjae.2010.58.3.256

ลัดดา ชูกลิ่น, สุจิตรา ทองแก้ว, สุปราณี อุดมรัตนศิริชัย. ปัจจัยที่มีผลต่อการหนาวสั่นของผู้ป่วยที่

ได้รับยาระงับความรู้สึกด้วยวิธี Balance anesthesia. วารสารโรงพยาบาลกำแพงเพชร. 2543:39–52.

Berry FA. Postanesthetic care. in: Morgan GE, Mikhai MS, Murrang MJ, editors. Clinical anesthesiology. 3rd ed. New York: McGraw-Hill Companies; 2002. 936–50.

Mecca RS. Postoperative recovery. In: Barash PG, Cullen BF, Stoelting RK, editors. Clinical anesthesia. 5th ed. Philadelphia: Lippincott Williams & Wilkins; 2006. 1380–404.

Powell RM, Buggy DJ. Ondansetron given before induction of anesthesia reduces shivering after general anesthesia. Anesth Analg. 2000;90(6):1423–7. doi: 10.1097/00000539-200006000-00032.

Kelsaka E, Baris S, Karakaya D, Sarihasan B. Comparison of ondansetron and meperidine for prevention of shivering in patients undergoing spinal anesthesia. Reg Anesth Pain Med. 2006;31(1):40–45. doi: 10.1016/j.rapm.2005.10.010.

Shakya S, Chaturvedi A, Sah BP. Prophylactic low dose ketamine and ondansetron for prevention of shivering during spinal anaesthesia. J Anaesthesiol Clin Pharmacol. 2010; 26(4):465–9.

Asl ME, Isazadefar K, Mohammadian A, Khoshbaten M. Ondansetron and meperidine prevent postoperative shivering after general anesthesia. Middle East J Anesthesiol. 2011; 21(1):67–70.

Abdollahi MH, Forouzannia SK, Bagherinasab M, Barzegar K, Fekri A, Sarebanhassanabadi M, et al. The effect of ondansetron and meperedin on preventing shivering after off-pump coronary artery bypass graft. Acta Med Iran. 2012;50(6):395–8.

Paech MJ, Salman S, Ilett KF, O'Halloran SJ, Muchatuta NA. Transfer of parecoxib and its primary active metabolite valdecoxib via transitional breastmilk following intravenous parecoxib use after cesarean delivery: A comparison of naive pooled data analysis and nonlinear mixed-effects modeling. Anesth Analg. 2012;114(4):837–44. doi: 10.1213/ANE.0b013e3182468fa7.

Elmawgood AA, Rashwan S, Rashwan D. Effect of parecoxib on remifentanil induced postoperative shivering. Egy J Anaesth. 2014;30:399–403. doi: 10.1016/j.egja.2014.05.001

Li X, Zhou M, Xia Q, Li W, Zhang Y. Effect of parecoxib sodium on postoperative shivering: a randomised, double-blind clinical trial. Eur J Anaesthesiol. 2014;31:225–30. doi: 10.1097/01.EJA.0000436684.94403.1e.

Du X, Zhou C, Huang B, Ruan L, Liang R, Pan L. The effects of parecoxib sodium and flurbiprofen axetil injection on postoperative shivering: A randomized, double-blinded clinical trial. Int J Clin Exp Med. 2016;9(5):8543–9.