Comparative study between combined Dexmedetomidine & ketamine versus each drug alone for prevention of shivering in spinal anesthesia

Background: Shivering is a prevalent adverse effect of spinal anaesthesia (SA) that can increase metabolic demand and patient discomfort, prompting the use of pharmacologic agents such as dexmedetomidine and ketamine, both known for their anti-shivering properties through distinct mechanisms. Aim: To contrast dexmedetomidine and ketamine versus each drug alone for the prevention of shivering in SA. Methods: This prospective randomized double-blinded comparative trial was performed on 120 patients planned for elective lower abdominal or lower limb surgical operations with American Society of Anaesthesiologists physical status I-II and the duration of surgery less than 120 minutes. Participants had been assigned at random to three equal groups. Results: In group KD, compared to group D and group K, the occurrence of shivering and hypothermia was significantly lower (P<0.05). With a p-value of only 0.014, group KD had much less severe shaking than groups D and K. Group D and group KD had a noticeably lower heart rate (HR) than group K at 15 minutes, 55 minutes, and 70 minutes (P-value<0.05). Compared to group-K, the HR in (group-D and group KD) was significantly lower at 25 and 40 minutes, and it was even lower in group-KD compared to group-D (P-value <0.05). Conclusions: Combination of dexmedetomidine with ketamine is superior to ketamine or dexmedetomidine alone in the shivering prevention following spinal anaesthesia with better hemodynamic stability, with comparable incidence of complications among them.