COMPARISON OF PROPHYLACTIC USE OF INTRAVENOUS PARACETAMOL VERSUS INTRAVENOUS DEXAMETHASONE TO PREVENT POSTOPERATIVE SHIVERING AFTER GENERAL ANESTHESIA IN LAPAROSCOPI CHOLECYSTECTOMY
- Authors
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Bushra Hameed
Author
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Arif Ur Rehman
Author
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Farah Niaz Awan
Author
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- Keywords:
- Anesthesia, Dexamethasone, Laparoscopic Cholecystectomy, Pain, Paracetamol, Postoperative Complications, Shivering
- Abstract
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Background: Laparoscopic cholecystectomy is a common minimally invasive procedure that, despite faster recovery and reduced complications, carries a significant risk of postoperative shivering. The incidence of this complication ranges between 5% and 66% among patients emerging from general anesthesia, leading to discomfort, increased oxygen consumption, and potential metabolic derangements. Pharmacological interventions, including paracetamol and dexamethasone, have been evaluated for prophylactic control of shivering, but their comparative efficacy in laparoscopic cholecystectomy remains underexplored.
Objective: To compare the efficacy of prophylactic intravenous paracetamol and intravenous dexamethasone in preventing postoperative shivering in patients undergoing laparoscopic cholecystectomy under general anesthesia.
Methods: This quasi-experimental study was conducted in the Department of Anesthesiology, Shaikh Zayed Hospital Lahore, over twelve months. Seventy-six patients aged 40–60 years, ASA I–II, scheduled for elective laparoscopic cholecystectomy were enrolled using convenient sampling and randomized into two equal groups. Group A received intravenous paracetamol (15 mg/kg in 100 ml saline) and Group B received intravenous dexamethasone (0.5 mg/kg). Standardized anesthetic protocols were followed, and intraoperative conditions were controlled. Postoperatively, shivering scores, heart rate, systolic and diastolic blood pressures, oxygen saturation, and complications such as postoperative nausea and vomiting (PONV) and pruritus were assessed at 15-minute intervals up to 120 minutes. Data were analyzed using SPSS version 20, with independent-samples t-test and chi-square applied, and significance set at p≤0.05.
Results: At 30 minutes, 68.4% of patients in the paracetamol group and 100% in the dexamethasone group were free from shivering (p<0.001). By 120 minutes, complete absence of shivering was achieved in all patients. Pain scores decreased to 1.5 ± 1.4 in the dexamethasone group versus 3.7 ± 0.6 in the paracetamol group at 60 minutes (p=0.015). The incidence of PONV fell to 0% in the dexamethasone group by 45 minutes compared with 15.8% in the paracetamol group (p=0.010). Oxygen saturation reached 100% in the dexamethasone group by 105 minutes, whereas Group A remained at 96.1 ± 1.9 (p=0.002). Hemodynamic stability was also significantly greater in the dexamethasone group across all time points.
Conclusion: Intravenous dexamethasone demonstrated superior efficacy over paracetamol in preventing postoperative shivering, reducing pain, minimizing PONV, and improving oxygen saturation in patients undergoing laparoscopic cholecystectomy. Its use as a prophylactic adjunct is strongly supported for enhancing recovery and patient comfort.
- Author Biographies
- References
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1. Della Corte L, Mercorio A, Morra I, Riemma G, De Franciscis P, Palumbo M, et al. Spinal Anesthesia versus General Anesthesia in Gynecological Laparoscopic Surgery: A Systematic Review and Meta-Analysis. Gynecol Obstet Invest. 2022;87(1):1-11.
2. Wang X, Guo K, Sun J, Yang Y, Wu Y, Tang X, et al. Semirecumbent Positioning During Anesthesia Recovery and Postoperative Hypoxemia: A Randomized Clinical Trial. JAMA Netw Open. 2024;7(6):e2416797.
3. Zhang Q, Ye X, Shi S, Zhou S, Ma D, Ouyang W, et al. Pyridoxine Prevents Postoperative Nausea and Vomiting in Gynecologic Laparoscopic Surgery: A Double-blind Randomized Controlled Trial. Anesthesiology. 2025;142(4):655-65.
4. Carstensen SW, de la Cour KD, Peterslund P. [Not Available]. Ugeskr Laeger. 2024;186(27).
5. Ahmed U, Ullah H, Samad K. Mean Temperature Loss During General Anesthesia for Laparoscopic Cholecystectomy: Comparison of Males and Females. Cureus. 2021;13(8):e17128.
6. Toleska M, Shosholcheva M, Dimitrovski A, Kartalov A, Kuzmanovska B, Dimitrovska NT. Is Multimodal Anesthesia Effecting Postoperative Nausea and Vomiting in Laparoscopic Cholecystectomy? Pril (Makedon Akad Nauk Umet Odd Med Nauki). 2022;43(2):51-8.
7. Buchwald H, Menchaca H, Michalek V, Erdman A. Insufflation-Free, Perianal Work Platform. Surg Innov. 2024;31(4):392-3.
8. Massoth C, Schwellenbach J, Saadat-Gilani K, Weiss R, Pöpping D, Küllmar M, et al. Impact of opioid-free anaesthesia on postoperative nausea, vomiting and pain after gynaecological laparoscopy - A randomised controlled trial. J Clin Anesth. 2021;75:110437.
9. Croghan SM, Mohan HM, Breen KJ, McGovern R, Bennett KE, Boland MR, et al. Global Incidence and Risk Factors Associated With Postoperative Urinary Retention Following Elective Inguinal Hernia Repair: The Retention of Urine After Inguinal Hernia Elective Repair (RETAINER I) Study. JAMA Surg. 2023;158(8):865-73.
10. Indra Rachman R, Birowo P, Nurullah G, Cho PSY, Atmoko W, Widyahening IS, et al. General versus spinal anesthesia in percutaneous nephrolithotomy: A systematic review and meta-analysis. F1000Res. 2023;12:281.
11. Nam SW, Do SH, Hwang JW, Park I, Hwang I, Na HS. Effects of opioid-sparing general anesthesia on postoperative nausea and vomiting in laparoscopic gynecological surgery. Korean J Anesthesiol. 2024;77(6):605-13.
12. Luo Z, Cao H, Luo L, Chen L, Feng D, Huang G. Comparison of remimazolam tosilate and propofol during induction and maintenance of general anesthesia in patients undergoing laparoscopic cholecystectomy: a prospective, single center, randomized controlled trial. BMC Anesthesiol. 2024;24(1):226.
13. Chen L, He W, Liu X, Lv F, Li Y. Application of opioid-free general anesthesia for gynecological laparoscopic surgery under ERAS protocol: a non-inferiority randomized controlled trial. BMC Anesthesiol. 2023;23(1):34.
14. Esmat IM, Mohamed MM, Abdelaal WA, El-Hariri HM, Ashoor TM. Postspinal anesthesia shivering in lower abdominal and lower limb surgeries: a randomized controlled comparison between paracetamol and dexamethasone. BMC Anesthesiology. 2021;21(1):262.
15. Esmat IM, Mohamed MM, Abdelaal WA, El-Hariri HM, Ashoor TM. Postspinal anesthesia shivering in lower abdominal and lower limb surgeries: a randomized controlled comparison between paracetamol and dexamethasone. BMC anesthesiology. 2021;21(1):1-13.
16. Yeoh CN, Voon B, Mahdi DDSNM, Masri SNNS, Izaham A. Evaluating effect of prophylactic intravenous dexamethasone in post spinal shivering: a single centre randomised controlled study. IIUM Medical Journal Malaysia. 2021;20(4).
17. Saheban Maleki M, Sedaghati Ansari S, Rezaniazave F, Talai A. Comparing intravenous dexamethasone, pethidine, and ketamine for postoperative shivering prevention in patients undergoing general anesthesia. Internal Medicine Today. 2021;27(3):288-301.
18. Wu C, Luo D, Zhu Y, Zhao Q, Wang J, Dai Y. Efficacy of combining intravenous and topical dexamethasone against postoperative pain and function recovery after total knee arthroplasty: A prospective, double-blind, randomized controlled trial. Journal of Orthopaedic Surgery. 2023;31(2):10225536231189782.
19. Elkabarity RH, Labib HAA, Elfar MM, Sharaf MMMI. A Comparative Study between Dexamethasone versus Paracetamol Added to Xylocaine in Local Intravenous Anesthesia in Upper Limb Minor Surgeries. QJM: An International Journal of Medicine. 2021;114(Supplement_1):hcab086. 2.
20. Nouh MMMK, Elrehiem GAMA, Elkadi, Aboseif EMK, Hamid FSAE, Mowafi MMMA. A randomized, comparative study of prophylactic intravenous acetaminophen, dexamethasone and pethidine regarding the incidence of post spinal anesthesia shivering in lower limb orthopedic surgeries. Anaesthesia, Pain & Intensive Care. 2023;27(2):185-90.
21. Selzer A, Pryor KO, Virginia T, Kjaer K. The effect of intravenous dexamethasone on postoperative nausea and vomiting after Cesarean delivery with intrathecal morphine: a randomized-controlled trial. Canadian Journal of Anesthesia. 2020;67(7):817-26.
22. Nazemroaya B, Keleidari B, Arabzadeh A, Honarmand A. Comparison of Intraperitoneal Versus Intravenous Dexamethasone on Postoperative Pain, Nausea, and Vomiting After Laparoscopic Cholecystectomy. Anesthesiology and Pain Medicine. 2022;12(2).
23. ur Rehman A, Aziz R, Hameed T, Haider S, Hai A, Ahsan S. Efficacy of dexamethasone in prevention of postoperative nausea and vomiting in laparoscopic cholecystectomy. The Professional Medical Journal. 2023;30(10):1241-6.
24. Kothari D, Sivaranjani S, Sharma R, Rai U. Effect of single dose preemptive intravenous paracetamol, dexamethasone, and magnesium sulfate on perioperative hemodynamic variables and post-operative nausea, vomiting, and pain in open cholecystectomy done under general anesthesia: A prospective, randomized, and single-blind study. Asian Journal of Medical Sciences. 2023;14(3).
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- 2025-08-31
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Copyright (c) 2025 Bushra Hameed, Arif Ur Rehman, Farah Niaz Awan (Author)
This work is licensed under a Creative Commons Attribution 4.0 International License.
