Postspinal Shivering: The Host of Details That Matter!

Dear Editor, The recent issue of your esteemed journal features an interesting article where Suryawanshi and Tudimilla compare the efficacy of dexmedetomidine and nalbuphine for managing postspinal shivering in a cohort of 60 surgical patients.[1] Acknowledging the clinical value of the index prospective randomized study, detailing the research subject in the light of the following observations, would make for an engaging discussion.[1-5] The authors declare that their sample size computation was based on the findings of a study by Megalla and Mansour, involving a specific patient subset undergoing vaginal hysterectomy.[1,2] Ahead of the closely related research objective of the two endeavors, the dosage of drugs employed by the latter group (0.07 mg/kg nalbuphine and 0.5 mcg/kg dexmedetomidine)[2] happens to be different from those used in the present study (0.05 mg/kg nalbuphine and 1 mcg/kg dexmedetomidine).[1] Even more importantly, given that Suryawanshi and Tudimilla relied on the corresponding grades of shivering for the sample size estimation, the potential clinical impact of the drug dosage on the same can simultaneously be difficult to overlook.[1,2] In addition, the contextual role of the changes in core temperature, cannot be undermined.[3] While measuring the axillary temperature across their patients, the absence of monitoring the core temperature ought to have been presented by the authors as an important limitation of the study, pretty much like the way Megalla and Mansour discuss the allied matter.[1-3] Moreover, the site (abdomen versus extremity) and the nature of surgery (superficial versus deep can) have concurrent implications on the degree of heat loss (core temperature).[3] Therefore, specifying these details and whether (or not) the two study groups were comparable with respect to the type of surgeries would have offered useful information for the readers.[1,3] Further, the study methodology categorically narrates having randomized the patients with postspinal shivering severity of grade 3 or more, to receive either of the pharmacological intervention.[1] Following up with the study results, it is intriguing to discover that all the participants were eventually eligible for an intervention which when evaluated in the light of the literature reporting an incidence of 50–80%, only goes on to again buttress the importance of comparing the type of surgery between the study groups.[1,4] At last, factors like patient anxiety when evaluating postspinal shivering as an outcome of interest can be equally relevant, considering a recent study by Jeevan et al.[5] happens to outline intricate links between preoperative anxiety and shivering in patients undergoing caesarean section under spinal anesthesia.[1] Data availability statement Nil. Author contributions RM contributed in conceptualization, literature search, reviewing, and editing. NC contributed in writing original draft and literature search. Financial support and sponsorship None. Conflicts of interest None.