
Effect of Intrathecal Bupivacaine Kept at Room Temperature versus Body Temperature on Shivering During Lower Limb Orthopaedic Surgery Under Spinal Anaesthesia: A Double-blind Randomised Controlled Trial
UC18-UC22
Correspondence
Dr. Urvashi Yadav,
Professor, Department of Anaesthsia, Uttar Pradesh University of Medical Sciences Saifai, Etawah-206130, Uttar Pradesh, India.
E-mail: drurvikgmu@gmail.com
Introduction: Perioperative shivering is very common after spinal anaesthesia. Shivering can cause discomfort, interfere with monitoring and lead to serious complications, particularly in patients with cardiorespiratory disorders.
Aim: To compare the effect of intrathecal bupivacaine at room temperature and body temperature on perioperative shivering in patients undergoing lower limb orthopaedic surgery.
Materials and Methods: This randomised, double-blind study was conducted at Uttar Pradesh University of Medical Sciences, Etawah, Uttar Pradesh, India, which included 70 patients of either sex, aged 18-65 years, classified as American Society of Anaesthesiologists (ASA) physical status I and II and scheduled for lower limb orthopaedic surgery under spinal anaesthesia. Patients were randomly allocated into two groups. All patients received a subarachnoid block with 3 mL of 0.5% bupivacaine heavy combined with 10 μg of fentanyl. Group W received the study drug stored at body temperature (35±1°C), while group C received the study drug stored at room temperature (20±1°C). The primary outcome measured was the incidence of shivering; the secondary outcomes measured were the onset and severity of shivering and changes in body temperature. Side-effects of spinal anaesthesia, including bradycardia, hypotension, nausea and vomiting, were also noted. Data were expressed as mean and standard deviation for continuous variables and numbers and percentages for categorical variables. An independent t-test was used to compare the means between the groups and a Chi-square test was used for categorical variables.
Results: Both groups were comparable in terms of demographic parameters such as age, weight and height (p-value>0.05) as well as haemodynamic status. The incidence of shivering was 11 (31.43%) patients in group W and 25 (71.43%) patients in group C; the difference was statistically significant (p-value <0.001). The onset time of shivering in group W was 13 minutes compared to four minutes in group C (p-value=0.015). In group C, 40% of patients developed shivering of grade more than one, compared to 22.86% in group W.
Conclusion: Warming intrathecal bupivacaine to body temperature significantly reduces the incidence, delays the onset and decreases the severity of perioperative shivering in patients undergoing lower limb orthopaedic surgery under spinal anaesthesia, compared to bupivacaine administered at room temperature.