the Use of Magnesium Sulfate for Prevention of Postspinal Shivering
Condition: Prevention of Postspinal Shivering
Study type: Interventional
Phase: Phase 4

Summary: 
      Shivering is an unpleasant experience after spinal anesthesia. Shivering is defined as an
      involuntary, repetitive activity of skeletal muscles. The mechanisms of shivering in patients
      undergoing surgery are mainly intraoperative heat loss, increased sympathetic tone, pain, and
      systemic release of pyrogens. Spinal anesthesia significantly impairs the thermoregulation
      system by inhibiting tonic vasoconstriction, which plays a significant role in temperature
      regulation. Spinal anesthesia also causes redistribution of core heat from the trunk (below
      the block level) to the peripheral tissues. These two effects predispose patients to
      hypothermia and shivering. The median incidence of shivering related to regional anesthesia
      observed in a review of 21 studies is 64.4%. Shivering increases oxygen consumption, lactic
      acidosis, carbon dioxide production, and metabolic rate by up to 400%. Therefore, shivering
      may cause problems in patients with low cardiac and pulmonary reserves. The best way to avoid
      these intraoperative and postoperative shivering-induced increases in hemodynamic and
      metabolic demands is to prevent shivering in the first place. Although magnesium is among
      several pharmacological agents used for the treatment of shivering, its effects on prevention
      of shivering during central neuraxial blockade have not been evaluated to date. Henceforth,
      the aim of this study was to evaluate the effect of magnesiume on shivering during spinal
      anesthesia.

      Aim:

      to compare the efficacy of intravenous versus intrathecal magnesium sulphate for prevention
      of post spinal shivering in adult patients undergoing elective lower limb orthopedic
      surgeries.
    


Intervention name(s): Magnesium Sulfate 1000 MG
Intervention type(s): Drug
Intervention description(s): intrathecal versus IV infusion of Magnesium sulfate for prevention of postspinal shivering
Intervention MeSH terms: Magnesium Sulfate
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: The patients will be randomly allocated to Groups ([T], Intrathecal MgSo4 and [M], IV infusion MgSo4 groups) on the basis of computer-generated random numbers. Patients belonging to Group T (n = 45) will receive 50 mg intrathecal MgSo4 added to 0.5% hyperbaric bupivacaine [131],while those belonging to Group M (group, n = 45) will receive IV magnesium sulfate 50 mg/kg in 100 mL isotonic saline over 20 min as a bolus then 2 mg/kg/h infusion using a separate infusion set after administering spinal anesthesia.
Axillary temperature and grades of shivering will be noted every 10 min by the same anesthesiologist who performed the spinal anesthesia using Crossley and Mahajan scale,[8] If grade III, IV shivering persisted for >10 min pethidine 25 mg IV will be administered as a rescue drug and number of patients required rescue drug will be recorded.
Masking: Single (Participant)
Primary purpose: Prevention
Keywords: Magnesium Sulfate - postspinal shivering -intrathecal - infusion