الفهرس 
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Abstract
Background Shivering is among the common troublesome complications of spinal anesthesia (SA), and causes discomfort and discontentment in parturients undergoing cesarean section (CS).
Objective: to investigate the effects of intrathecal dexmedetomidine (DEX) as an adjuvant to heavy bupivacaine in the prevention of shivering in those who underwent CS under SA.
Methods: A prospective double-blind conducted at Ain Shams University hospitals on 100 parturients who are undergoing CS under Spinal anesthesia over a period of six months starting from December 2018 to May 2019 at Ain shams university hospitals. Patients were randomly subdivided into 2 groups of 50 patients each, group BD: 5 micrograms DEX was added to 12.5 mg 0.5% heavy bupivacaine. group BN: 0.5 mL 0.9% normal saline was added to the 12.5mg 0.5% of heavy bupivacaine.
Results: The incidence of shivering was significantly higher in the BN group (56%) than the BD group (24%). Likewise, the intensity of shivering was significantly higher in the BN group than the BD group.
Conclusion: Intrathecal DEX in conjugation with heavy bupivacaine reduced the incidence and intensity of shivering in patients undergoing cesarean section after spinal anesthesia and did not increase the incidence of hypotension or bradycardia.
INTRODUCTION
Spinal anesthesia is a widely used technique for elective or emergency Cesarean delivery as it provides adequate anesthesia and analgesia for this purpose (He et al., 2017).
Even-though the risk of complications of spinal anesthesia is lower than that of general anesthesia, the adverse events caused by spinal anesthesia, such as shivering, are still present during surgical procedures, causing discomfort for the patients (Miao et al., 2018).
Shivering is defined as an involuntary, repetitive activity of skeletal muscles (Usta et al., 2011). It is one of the most common troublesome complications following neuraxial anesthesia, and causes discomfort and dissatisfaction in parturients undergoing cesarean sections (CSs). A review of 21 studies showed that the median incidence of shivering after neuraxial anesthesia was 55% (Nasseri et al., 2017).
Dexmedetomidine is a selective α-2 adrenergic agonist possessing hypnotic, sedative, anxiolytic, sympatholytic, opioid-sparing and analgesic properties without producing significant respiratory depression. Small doses of dexmedetomidine (3-5μg) used in combination with spinal bupivacaine produce a quicker onset of motor block and a prolongation in the duration of motor and sensory block with preserved hemodynamic stability. It also increases the shivering threshold (Bhuvana et al., 2017).