Assessment of Diclofenac Sodium Infusion for Management of Post-Spinal Shivering

Abstract

Sodium diclofenac was proved to be effective in decreasing post-spinal shivering when given as a suppository preoperatively.[ 1][2] The role of diclofenac sodium in treating established post-spinal shivering is not yet known. This drug is commonly used as an intravenous infusion or intramuscular injection peri-operatively rather than a suppository. Aim: to investigate the ability of intravenous infusion of diclofenac sodium to treat established post-spinal shivering. Settings: A randomized, prospective, double-blind, placebo-controlled study. Methods: Ninety patients aging 18-65 years scheduled for urological, inguinal or lower limb surgeries under spinal anesthesia were divided into 3 groups; Group I received intravenous infusion of diclofenac sodium 1 mg/kg (maximally 75 mg) diluted in 50 ml of dextrose 5%. Group II received intravenous infusion of pethidine 0.35 mg/kg diluted in 50 ml of dextrose 5%. Group III received intravenous infusion of dextrose 5% as a control group. All study drugs were given over 10 minutes when shivering starts. Time needed for cessation of shivering was recorded. Hemodynamic data (heart rate and arterial blood pressure) and body temperature was recorded every 5 minutes for 45 minutes Statistical Analysis: Chi-square test was used for qualitative data and One-Way Analysis of Variance (ANOVA) followed LSD test as a post hoc test was used for quantitative data. Results: No significant differences were detected between groups concerning age, gender, type and duration of surgery. There was no statistically significant difference found between groups regarding grade of shivering. Cessation of shivering was recorded in 7 patients (23.3%) in group I compared with 26 (86.7%) and 3 (10%) patients in groups II and III respectively. There was no statistically significant difference between the three studied groups regarding temperature except after 25 minutes where Group II was significantly warmer than Group I. No statistically significant difference between groups regarding arterial blood pressure. There was no statistically significant difference between groups regarding heart rate except after 40 minutes where Group III showed a significantly higher rate compared with other groups. Conclusion: Intravenous infusion of diclofenac sodium was less effective than pethidine in treating post-spinal shivering. Although diclofenac sodium was successful than placebo, Results was statistically insignificant. Higher doses of diclofenac sodium or bigger sample size may be needed to reach significance.