Comparison of The Effects of Two Different Local Anesthetics Used in Spinal Anesthesia on Peripheral and Central Temperature Change: A Randomized Controlled Trial

Comparison of The Effects of Two Different Local Anesthetics Used in Spinal Anesthesia on Peripheral and Central Temperature Change: A Randomized Controlled Trial | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Comparison of The Effects of Two Different Local Anesthetics Used in Spinal Anesthesia on Peripheral and Central Temperature Change: A Randomized Controlled Trial Azra Ozanbarci, Hatice Kilinc, Bunyamin Muslu, Safinaz Karabayirli, and 6 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5588869/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 29 May, 2025 Read the published version in BMC Anesthesiology → Version 1 posted 7 You are reading this latest preprint version Abstract Objective: In this study, we aimed to compare the effects of two different local anesthetics with different baricity used in spinal anesthesia on thermoregulation. Materials and Methods: Our study was conducted on forty full-term pregnant women scheduled for elective cesarean sections under spinal anesthesia. At an operating room temperature of twenty-four degrees Celsius, peripheral body temperature was measured using temperature probes attached to the lower medial parts of the same side's lower and upper extremities, and central body temperature was measured with a tympanic thermometer. Isobaric levobupivacaine and hyperbaric bupivacaine were used in spinal anesthesia applications. After spinal anesthesia, tympanic temperature, arm and leg temperatures, mean arterial pressure, heart rate, and oxygen saturation were measured and recorded at baseline, the first, third, and fifth minutes, and every five minutes thereafter until the end of surgery. Results: In the bupivacaine group, a decrease in tympanic temperature was observed at the third minute and an increase in leg skin temperature at the fifth minute compared to baseline values. In the levobupivacaine group, a decrease in tympanic temperature was observed at the fifth minute, and an increase in leg skin temperature was observed at the third minute. In both groups, within-group comparisons showed a continued decrease in tympanic temperature and increase in leg temperature at all subsequent time points compared to baseline. No statistically significant difference was observed in arm skin temperatures within groups in either group. Conclusion: We observed that the effects of hyperbaric bupivacaine and isobaric levobupivacaine used in spinal anesthesia on thermoregulation were similar. Spinal anesthesia local anesthetics thermoregulation baricity Figures Figure 1 Figure 2 INTRODUCTION Spinal anesthesia is widely accepted today as a safe method used in many operations, especially in lower abdominal and extremity surgeries. Recent meta-analyses have further confirm edits safety profile, even in high-risk populations such as elderly patients undergoing hip fracture repair, though careful monitoring of hemodynamic changes remains essential.Moreover,the safety and effectiveness of spinal anesthesia depend on the correct selection and appropriate use of local anesthetics 1 .It is not widely known that spinal anesthesia causes fluctuations in body temperature as much as, or even more than, general anesthesia. There is a lot of literature showing that the temperature decrease in regional anesthesia is similar or even greater than in general anesthesia 2 , 3 .Much of thelack of knowledge about hypothermia during regional anesthesia could be based on thelack of monitoring in these patients. It could serve as a justification to carry out clinical trials in patients under regional anesthesia 4 – 7 .In patients undergoing spinal or epidural anesthesia, as in general anesthesia, the primary cause of hypothermia is the redistribution of body heat. Neuroaxial anesthesia centrally inhibits thermoregulatory control but has a much more significant effect by blocking peripheral and motor nerves that prevent thermoregulatory vasoconstriction and shivering 8 – 13 . The redistribution that continues during neuroaxial anesthesia is typically limited to the legs. The weight of the legs far exceeds that of the arms and thus contributes much more significantly to redistribution 14 . Isobaric levobupivacaine and hyperbaric bupivacaine are agents frequently used in spinal anesthesia. Comparative studies have been conducted with various doses in many types of operations 15 – 17 . Although there are numerous in vitro studies showing changes in local anesthetic densities at different temperatures, we found very few studies demonstrating the clinical effects of these changes 19 – 23 . The effect of temperature is particularly pronounced in diluent solutions; for example, 0.5% bupivacaine and levobupivacaine are slightly hyperbaric at room temperature (20–24°C) and slightly hypobaric at body temperature (30–37°C) 23 – 25 . Therefore, these changes in baricity lead to variations in the spread of local anesthetics within the cerebrospinal fluid (CSF) and affect the level of motor and sensory block. Previous comparative studies have been conducted on the effects of regional and general anesthesia on core and skin temperatures. However, we did not find any studies comparing the effects of local anesthetics with different baricities on body temperatures. In this study, we aimed to compare the effects of two local anesthetics with different baricities, hyperbaric bupivacaine and isobaric levobupivacaine, on central and peripheral body temperatures in patients undergoing spinal anesthesia and the potential influence of the baricity of the local anesthetic in decreasing the extent of the blockade of the sympathetic nervous system and thus decreasing the extent of the vasodilation caused. MATERIALS AND METHODS After obtaining approval from the Fatih University Faculty of Medicine Ethics Committee, at 21.02.2014 with code number 33/5, our study was comply with the principles of the Declaration of Helsinki and conducted on 40 full-term pregnant women aged 18-40, classified as ASA I-II, who were scheduled for elective cesarean sections under spinal anesthesia. All patients included in the study were informed and gave their written and verbal consent 2 hours before the surgery. Our study was planned as a mono centric, prospective, randomized,double-blind trial. A computer-generated random sequence was used for allocation. The groups were divided into the bupivacaine group (Group B) and the levobupivacaine group (Group L) (Figure 1). Neither the physician nor the patient knew which group they are in. Another physician enrolled participants, and who assigned participants to interventions. Exclusion criteria were patients for whom spinal anesthesia was contraindicated, those with neuromuscular diseases, alcohol and substance abusers, patients with a body mass index (BMI) 35 kg/m², those using medications that could affect thermoregulation such as vasodilators, patients with thyroid disorders, those with fever and infection, and expectant mothers known to have allergies to the study drugs. For all patients brought to the operating room, an intravenous line was established using a 22-gauge catheter on the dorsum of the hand, and an infusion of room-temperature Ringer's lactate at 10 ml/kg was initiated to be administered over half an hour before spinal anesthesia. The operating room temperature was maintained at a constant 24°C, monitored by an electronic temperature monitor. Blood pressure was monitored using a non-invasive automatic sphygmomanometer, heart rhythm was monitored with a five-lead electrocardiogram (ECG), and peripheral oxygen saturation was monitored with a pulse oximeter. Temperature probes (Philips temperature probes, Biyoplus Medical TM, Yalova) attached to the lower medial parts of the same side's lower and upper extremities were used to measure peripheral body temperature, and a tympanic thermometer (Covidien GeniusTM 2, USA) was used to measure central body temperature. All patients' external auditory canals were examined using an otoscope (Rieste, Tuttlingen, Germany), and any cerumen was removed by an ear, nose, and throat specialist. Demographic data (age, weight, height) of all expectant mothers were recorded before the block. Baseline values for mean arterial pressure (MAP), heart rate (HR), oxygen saturation (SpO2), lower and upper extremity temperatures, and tympanic membrane temperature were recorded before anesthesia. The application was performed by a different physician, and the follow-up was conducted by another physician unaware of the application. All patients were positioned sitting. The puncture site was disinfected with a 10% povidone-iodine antiseptic solution and covered with a sterile drape. Using a 27-gauge Whitacre pencil point spinal needle (B.BraunMelsungen A.G., Germany), the spinal space was accessed through the L3-L4 or L4-L5 interspinous space, and after observing the free flow of cerebrospinal fluid (CSF), 2-2.5 ml of room-temperature hyperbaric 0.5% bupivacaine (15 ml,75 mg) (10-12,5 mg) (Marcaine® spinal heavy, 0.5%, Astra Zeneca, Istanbul) was administered to the bupivacaine group (Group B), and 2-2.5ml (10-12,5 mg) of room-temperature 0.5% levobupivacaine (15 ml, 75 mg) (Chirocaine®, 0.5%, Abbott Laboratories, Istanbul) was administered to the levobupivacaine group (Group L). After the procedure, patients were positioned 15° supine on the left side and 30° head-up. Sensory block was determined bilaterally using the pinprick test along the midclavicular line. The sensory block level of the patient was measured and recorded from the 3rd minute after spinal anesthesia. Once it was confirmed that an adequate block level for the operation was achieved, surgery was allowed to proceed. The patient's MAP, HR, SpO2, tympanic temperature, and peripheral temperatures from the arm and leg were measured and recorded at baseline, and then at 1, 3, and 5 minutes after anesthesia administration, followed by 5-minute intervals. In cases of severe hypotension (when MAP fell below 20% of preoperative values), 10 mg of ephedrine was planned to be administered, and in cases of bradycardia (HR values below 20% of preoperative values), 0.5 mg of atropine was to be administered. Patients were asked if they experienced any complaints of cold or shivering. No sedatives, hypnotics, or narcotic drugs were administered to the patients. Sample size: The power analysis conducted using the means and standard deviations obtained from the results of the study titled "The effect of bupivacaine with fentanyl temperature on initiation and maintenance of labor epidural analgesia: a randomized controlled study" indicated that, with a power of 80% and a significance level of 0.05, a minimum of 24 patients would need to be included in each group 26 . Statistical Analysis All statistical calculations were performed using SPSS for Windows software (Statistical Package for the Social Sciences), version 20 (SPSS Inc., Chicago, IL, USA). Parameters following a normal distribution were analyzed using the Student's t-test, while parameters not following a normal distribution were analyzed using the Mann-Whitney U test. The Friedman test was used for the comparison of variables within groups, and the Wilcoxon test was used for multiple comparisons after Bonferroni correction. Values are presented in the article, tables, and graphs as mean ± standard deviation (SD) or median (25th-75th percentiles). A p-value of <0.05 was considered statistically significant. RESULTS A total of 40 female patients scheduled for elective cesarean operations were included in our study. One patient from Group L was excluded due to data loss in temperature monitoring. The study was completed with 20 patients in Group B and 19 patients in Group L. When comparing the groups in terms of age, height, weight, operation duration, and the dose of drugs used for spinal anesthesia, no statistically significant differences were found (p >0.05) (Table 1). Table 1. Demographic Data Group B (n= 20) Group L (n= 19) P Age (Year) 29.3±5.03 31.0±3.2 0.220 a Height (cm) 164.6±5.8 164.5±6.1 0.949 a Weight (kg) 76.0±7.4 78.0±8.8 0.443 a Duration of operation(minute) 29.2±8.1 25.0±7.8 0.105 a Dose of Drug administered (ml) 2.4±0.1 2.5±0.1 0.054 a 0.054 a: Student’st-test No statistically significant differences were found in the comparison of HR, SpO2, and MAP between the groups (p > 0.05). In the intergroup comparisons of MAP measurements, a significant difference was only found in the basal values (p = 0.024). In Group B, a decrease in tympanic temperature at the 3rd minute and an increase in leg skin temperature at the 5th minute compared to basal values were observed, which was considered statistically significant (p < 0.05) (Table 2). In Group L, a decrease in tympanic temperature at the 5th minute and an increase in leg skin temperature at the 3rd minute compared to basal values were detected. This was considered statistically significant (p < 0.05) (Table 2). In both groups, the decrease in tympanic temperature and the increase in leg temperature continued at all time points compared to the baseline in within-group comparisons, and these changes were considered statistically significant (p < 0.05). Table 2. Within-Group Comparison of Tympanic and Leg Temperature in Group B and Group L Group B Group L Tympanic temperature P Leg temperature P Tympanic temperature P Leg temperature p Baseline 36.4 ±0.4 29.5±1.3 36.4±0.3 28.9±1.6 1 st minute 36.3±0.5 0.186 a 29.0±2.1 0.175 a 36.4±0.3 0.938 a 29.2±1.57 0.152 a 3 rd minute 36.1±0.5 0.003 a * 29.8±1.5 0.380 a 36.3±0.4 0.129 a 29.4±1.3 0.036 a * 5 th minute 36.07±0.4 0.044 a * 30.4±1.4 0.001 a * 36.1±0.5 0.004 a * 30.2±1.2 0.001 a * 10 th minute 35.9±0.4 0.001 a * 31.5±1.4 0.001 a * 35.8±0.3 0.001 a * 31.1±1.3 0.001 a * 15 th minute 35.8±0.4 0.001 a * 32.2±1.3 0.001 a * 35.7±0.4 0.001 a * 31.8±1.8 0.001 a * 20 th minute 35.7±0.4 0.001 a * 32.3±1.2 0.001 a * 35.7±0.5 0.001 a * 32.2±1.1 0.001 a * 25 th minute 35.4±0.6 0.001 a * 31.8±3.0 0.002 a * 35.6±0.5 0.001 a * 32.6±1.1 0.001 a * 30 th minute 35.3±0.7 0.007 a * 32.9±1.1 0.005 a * 35.8±0.4 0.009 a * 33.3±0.9 0.002 a * a: Student’s t-test Data are presented as mean ± SD. *p 0.05). When comparing the maximum changes in leg skin temperature and tympanic temperature at the 5th minute and subsequent times, no statistically significant differences were observed between the groups (p > 0.05) (Table 3, Figure 2). Table 3. Comparison of Tympanic and Leg Temperature Changes Between Groups Group B (n= 20) Group L (n= 19) P Change in leg skin temperature at the 5 th minute 0.8 (-1.5–3.2) 1.3 (-0.8–3.5) 0.167 b Maximum change in leg skin temperature 3.6 (0.2 –6.6) 3.8 (1.7 –6.7) 0.771 b Change in tympanic temperature at the 5 th minute -0.4 (-1.1 –0.2) -0.3 (-1.4 –0.5) 0.708 b Maximum change in tympanic temperature -0.8 (-1.3 –-0.1) -1.1 (-1.8 –-0.2) 0.113 b b :Mann- Whitney U Test Data are presented as median (min-max). No statistically significant differences were observed in the within-group comparison of arm skin temperatures in both groups (p > 0.05) (Table 4). Table 4. Comparison of ArmTemperature Changes Between Groups Group B (n= 20) Group L (n= 19) P Baseline 33.0 ±1.3 32.7 ±1.8 0.579 a 1 st minute 32.8±1.4 33.06±1.2 0.687 a 3 rd minute 32.5±1.2 32.6±1.3 0.794 a 5 th minute 32.3±1.5 32.6±1.4 0.654 a 10 th minute 32.6±1.6 32.8±1.5 0.736 a 15 th minute 32.6±1.4 32.9±1.3 0.573 a 20 th minute 32.9±1.4 32.9±1.5 0.862 a 25 th minute 32.8±1.5 32.9±1.6 0.893 a 30 th minute 32.6±1.7 33.7±1.1 0,236 a 35 th minute 32.7±2.1 34.7±0,2 0,214 a a: Student’s t-test Data are presented as mean ± SD In the comparison between groups, Group L was found to have a higher maximum sensory block level and a shorter time to reach maximum sensory block (p < 0.05).(Table 5). Table 5. Comparison of Sensory Block Characteristics Between Groups Group B (n= 20) Group L (n= 19) P Maximum Sensory Block Level 4(3–6) 3(3–3) 0.007 b * Time to Reach Maximum Sensory Level (min) 7.5(3–20) 5(5–5) 0.015 b * b : Mann-Whitney U Test Data are presented as median (min-max). *p < 0.05 was considered statistically significant. During the procedure, hypotension developed in 10 patients in Group B and 11 patients in Group L, while bradycardia developed in 2 patients in Group B and 1 patient in Group L, and these were treated. None of the patients experienced coldness or shivering. DISCUSSION Hypothermia can frequently occur during regional anesthesia and can be almost as severe as in general anesthesia. As in general anesthesia, the primary cause of hypothermia in patients undergoing spinal or epidural anesthesia is the redistribution of body heat. Frank et al. investigated the causes of hypothermia in patients undergoing spinal anesthesia and found that vasomotor inhibition following spinal anesthesia resulted in blood pooling in peripheral tissues, leading to heat loss and hypothermia 25 . Hypothermia occurs less frequently in regional anesthesia compared to general anesthesia. This may be due to the preservation of metabolic rate and vasoconstriction in the arms 14 . Matsukawa et al. evaluated heat redistribution under epidural anesthesia at a constant ambient temperature in 12 male volunteers. The initial hypothermia in the first hour following epidural anesthesia was mainly due to the redistribution of body heat from the internal thermal compartment to the distal legs, and it continued throughout the three-hour duration of anesthesia. It was shown that the arm heat content decreased three times more than the baseline in the three hours following epidural anesthesia. Despite the higher fractional contribution of redistribution in epidural anesthesia, it was noted that internal metabolic heat was preserved and vasoconstriction occurred in the arms, leading to less frequent temperature drops compared to general anesthesia 14 . In our study, the maximum decrease in tympanic temperature was -0.8 (-1.3 to -0.1)°C in the bupivacaine group and -1.1 (-1.8 to -0.2)°C in the levobupivacaine group, consistent with these studies. However, unlike the above study and their findings, the arm temperature values in our patients did not change compared to baseline. In contrast to these studies, other studies have shown that epidural anesthesia causes a higher rate of hypothermia compared to general anesthesia 27,28 . In a study conducted on 15 patients undergoing transvesical prostatectomy with epidural and standard general anesthesia, internal and superficial temperatures were measured before, during, and for the first 6 hours postoperatively. It was found that total and mean body temperatures dropped more rapidly in the epidural group, with statistically significant differences in the early postoperative period. In another study comparing the effects of lumbar epidural and general anesthesia on body temperatures, it was shown that the temperature drop was slower and shorter in the epidural anesthesia group, while it was faster and lasted longer in the general anesthesia group. Consequently, the number of patients with core temperatures below 35°C was higher in those receiving general anesthesia compared to those receiving epidural anesthesia. In our study, since the operation lasted less than an hour and postoperative temperature monitoring was not performed, we could not evaluate temperature changes in the later hours. In a study by Hopf et al. involving 53 patients undergoing high thoracic, mid-thoracic, and lumbar epidural anesthesia, bupivacaine and saline of the same volume were administered to each group to evaluate arm and leg temperatures. In the high thoracic application, it was found that temperature increased in the arms and legs of the bupivacaine group and decreased in the saline group. In the mid-thoracic injection, a significant increase in leg temperature was observed, with no change in the arms. Following lumbar injection, a significant increase in leg temperature and a decrease in arm temperature were observed. This supports the hypothesis of vasoconstriction occurring in the arms. While leg temperature changes were similar after high and mid-thoracic injections, the increase in leg temperature following lumbar injection was greater than that observed from the other two regions. This was attributed to sympathetic blockade related to the dermatomes involved. Skin temperature on the body either remained unchanged or significantly decreased in blocked areas. Assuming that increased leg temperature reflects decreased sympathetic activity, it was concluded that high and mid-thoracic segmental epidural anesthesia involving several dermatomes led to sympathetic blockade that included the most caudal part of the sympathetic nervous system. 13 . In our study, following spinal anesthesia, within-group comparisons showed that all measurements over time revealed a continued decrease in tympanic temperature and an increase in leg temperature compared to baseline. The maximum change in leg skin temperature increased by +3.6 (+0.2 – +6.6)°C in the bupivacaine group and by +3.8 (+1.7 – +6.7)°C in the levobupivacaine group, with no statistically significant difference observed between the groups. Unlike the studies mentioned above, no difference was detected in arm temperature measurements compared to baseline in our study. This could be due to the numerous factors affecting hypothermia andas well as the fact that our patients were term pregnant. In a large randomized study by Frank et al. investigating the effects of ambient temperature on hypothermia, 97 patients undergoing lower extremity vascular surgery with general and epidural anesthesia were included. It was observed that there was a significant relationship between operating room ambient temperature and type of anesthesia, with greater body temperature drops occurring with general anesthesia in the cold ambient temperature, but similar drops in warm ambient temperature with both general and epidural anesthesia 29 . Some studies have shown that hypothermia is also related to the patient's thermal condition and can be corrected by warming the skin before anesthesia induction. It was found that the drop in core temperature during epidural anesthesia was less in the warmed group. As a result, it was shown that preoperative warming reduced redistribution hypothermia during epidural block 29 . In our study, to eliminate the effects of ambient temperature, the operating room temperature was kept constant at 24°C for all patients. Additionally, 10 ml/kg of room-temperature Ringer's lactate was administered intravenously over half an hour before spinal anesthesia to minimize related changes. In a study by Goktuğ et al. on patients undergoing inguinal hernia surgery with spinal anesthesia, bupivacaine and levobupivacaine were compared in terms of blood pressure, pulse, motor block status, sensory block level, VAS values, and side effects. The onset time of sensory block was found to be significantly shorter in the levobupivacaine group compared to the bupivacaine group. When examining hemodynamic changes, no significant difference was found between the two groups 31 . In our study, the hemodynamic data, sensory and motor block onset times, and characteristics evaluated during the operation were consistent with other studies 16-18 . Esophageal temperature measurement is known to be the safest method for monitoring core temperature. Studies have shown that under stable conditions, there is a significant correlation between tympanic and esophageal temperatures 32-34 . In our study, we did not prefer esophageal temperature measurement for patients undergoing regional anesthesia, considering it to be invasive. Instead, we used tympanic membrane temperature measurement for core temperature monitoring. For peripheral temperature measurements, we used the forearm and calf temperatures. Due to the effect of subcutaneous fat tissue on heat distribution, we did not include patients who were very thin (body mass index 35 kg/m²) in our study. There was no significant difference between the two groups in terms of height, weight, and body mass index. Pregnancy is known to alter both the normal thermoregulatory response and the anesthetic response 34-36 . Only term pregnant patients were included in our study, so changes due to pregnancy were applicable to both groups. While there are in vitro studies demonstrating changes in the density of local anesthetics at different temperatures, we found few studies demonstrating the clinical effects of these changes 19-23 . McLeod used the mechanical oscillation resonance method to investigate the relationship between temperature and density, showing that densities at 37°C (0.99944 for 0.5% bupivacaine, 1.00024 for 0.5% levobupivacaine, and 0.99953 mg/mL for 0.5% ropivacaine) were lower than those at 23°C 37 . The effect of temperature is particularly pronounced in diluent solutions; for example, 0.5% bupivacaine and levobupivacaine are slightly hyperbaric at room temperature (20-24°C) and slightly hypobaric at body temperature (30-37°C) 23,24 . In light of these studies, we can say that the local anesthetic drugs we used were slightly hypobaric instead of hyperbaric and isobaric at body temperature, affecting core body temperature in the same direction as baricity. The limitations of our study include not calculating the basal temperature of the patients, absence of esophageal thermometer, not performing postoperative temperature monitoring and being a monocentric study.While all of the patients were pregnant, the study was carried out on women and there fore the application of the findings is not extensible too ther populations such as men, children or the elderly.The last limitation of our prospective study is conducted in 2014, did not receive a Clinical Trial Number, as it was not obtained at that time. CONCLUSION In conclusion, in our study evaluating central and peripheral temperatures following spinal anesthesia with isobaric levobupivacaine and hyperbaric bupivacaine, there was no difference between the groups in terms of the maximum increase in peripheral temperature and the level of central temperature decrease. However, much of the lack of knowledge about hypothermia during regional anesthesia could be based on the lack of monitoring in these patients. It could serve as a justification to carry out clinical trials in patients under regional anesthesia.We believe that adequate monitoring and precautions should be taken to avoid hypothermia, especially in long surgeries and at-risk groups, following spinal anesthesia. Declarations Ethics Approval And Consent To Participate: Ethical approval for this study (decision number:33/5) was provided by the Ethical Committee Turgut Ozal University Hospital, Ankara, Turkey on 21 February 2014. Consent For Publication: Not applicable Availability of Data and Materials: The data sets used and/or analysed during the current study available from the corresponding author on reasonable request. Conflicts of Interest: The authors have declared that no competing interests exist. Funding: This study received no grant from any funding agency in the public, commercial, or not-for-profit sectors. The authors have declared that no competing interests exist. Authors' Contributions: A.O, G.E.D, M.D conception or design of the work; A.K.,O.M., Y.D acquisition, analysis, interpretation of data; H.K.,B.M.,Se.K.,Sa.K. interpretation of data; A.O., G.E.D drafting the work and reviewing. Acknowledgments: We would like to thank Rüveyda İrem Demircioğlu, MD. Asist.Prof., Muhammed Gözdemir, MD. Asist.Prof., Bahadır Kösem, MD. specialist, who helped collect and evaluate part of data in this study. Data Access Statement: All relevant data are within the paper and its Supporting Information files. 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AnesthEssaysRes., 2015; 9 (1):57-62. https://pubmed.ncbi.nlm.nih.gov/25886422/ .Bremeric DH, Fetsch N, Zwissler BC, Meininger D, Gogarten W,Byhahn C. Comparison of intrathecal bupivacaine and levobupivacaine combinedwith opioids for Caesarean section. Curr Med Res Opin, 2007; 23(12):3047-54. https://pubmed.ncbi.nlm.nih.gov/17967219/ Herrera R, De Andres J, Estan L, Olivas FJ, Martinez-Mir I,Steinfelt T. Hemodynamic impact of isobaric levobupivacaine versushyperbaric bupivacaine for subarachnoid anesthesia in patients aged 65 andolder undergoing hip surgery. BMC Anesthesiol, 2014; 14:97. https://pubmed.ncbi.nlm.nih.gov/25371654/ Muslu B, Demircioğlu İR Muslu S, Karabayırlı S, Sert H, UstaB.SıcaklıkDeğişikliğininLokalAnestetik/OpioidKarışımıDansitesiÜzerineEtkisi.TurkJ AnesthReanim, 2012; 40 (5):279-83. https://turkmedline.net/detay/sicaklik-degisikliginin-lokal-anestetik-opioid-karisimi- dansitesi-uzerine-etkisi/a8ec7116206214d0/tr/112%2B2012%2B40%2B5 Heller AR, Zimmermann K, Seele K, Rössel T, Koch T, Litz RJ. Modifyingthe baricity of local anesthetics for spinal anesthesia by temperatureadjustment: model calculations. Anesthesiology, 2006; 105 (2):346-53. https://pubmed.ncbi.nlm.nih.gov/16871069/ StienstraR,GielenM,PoortenF,KroonJW. Spinalanesthesiawithplain bupivacaine 0.5%: regression of sensory and motor blockade withdifferent temperatures of the anesthetic solution. AnesthAnalg, 1989; 69 (5):593-7. https://pubmed.ncbi.nlm.nih.gov/2802194/ StienstraR,VanPoortenJF. The temperature of bupivacaine0.5%affectsthe sensory level of spinal anesthesia. AnesthAnalg, 1988; 67 (3):272-6. https://pubmed.ncbi.nlm.nih.gov/3344977/ NazliB,OğuzalpH,HorasanliE,GamliM,DikmenB,GogusN. The effect son sensorial block, motor block, and haemodynamics of levobupivacaine atdifferent temperatures applied in the subarachnoid space. Biomed Res Int, 2014;2014: 132687. https://pubmed.ncbi.nlm.nih.gov/24772412/ Callesen T, Jarnvig I, Thage B, Krantz T, Christiansen C. Influenceof temperature of bupivacaine on spread of spinal analgesia. Anaesthesia, 1991;46 (1):17-9. https://pubmed.ncbi.nlm.nih.gov/1996745/ Frank SM, El-Rahmany HK, Cattaneo CG, Barnes RA. Predictors ofhypothermia during spinal anesthesia. Anesthesiology, 2000; 92 (5):1330-4. https://pubmed.ncbi.nlm.nih.gov/10781278/ Sviggum, H. P., Yacoubian, S., Liu, X., & Tsen, L. C. (2015). The effect of bupivacaine with fentanyl temperature on initiation and maintenance of labor epidural analgesia: a randomized controlled study. International Journal of Obstetric Anesthesia, 24(1), 15-21. Hendolin H, Lansimies E. Skin and central temperatures duringcontinuous epidural analgesia and general anaesthesia in patients subjected toopen prostatectomy. Ann Clin Res, 1982; 14 (4):181-6. https://pubmed.ncbi.nlm.nih.gov/7168548/ HoldcroftA,HallGM,CooperGM.Redistributionofbodyheatduring anaesthesia. A comparison of halothane, fentanyl and epiduralanaesthesia. Anaesthesia, 1979; 34 (8):758-64. https://pubmed.ncbi.nlm.nih.gov/525732/ FrankSM,BeattieC,ChristophersonR,NorrisEJ,RockP,ParkerS, et al. Epidural versus general anesthesia, ambient operating roomtemperature, and patient age as predictors of inadvertent hypothermia. Anesthesiology,1992; 77 (2):252-7. https://pubmed.ncbi.nlm.nih.gov/1642343/ Glosten B, Hynson J, Sessler DI, Mc Guire J. Preanesthetic skin-surfacewarming reduces redistribution hypothermia caused by epidural block. AnesthAnalg, 1993; 77 (3):488-93. https://pubmed.ncbi.nlm.nih.gov/8368549/ Göktuğ A,Takmaz S,Uyar E,Başar H.İnguinal herni operasyonlarında 0.5% bupivakain ile 0.5% levobupivakainin anestezi kalitesi ve hemodinamik parametreler yönünden karşılaştırılması. TARD dergisi, 2006; 34:254-255. https://akademi.tard.org.tr/?p=bildiri&kID=4370&sec=209833736&session=42219986u126659958s211099931 Lopez M, Ozaki M, Sessler DI, Valdes M. Mild core hyperthermia does notalter electroencephalographic responses during epidural-enflurane anesthesiain humans. J Clin Anesth, 1993; 5 (5): 425-30. https://pubmed.ncbi.nlm.nih.gov/8217181/ Cork RC, Vaughan RW, Humphrey LS. Precision and accuracy of intraoperative temperature monitoring. AnesthAnalg, 1983; 62 (2):211-4. https://pubmed.ncbi.nlm.nih.gov/6829923/ Shiraki K, Sagawa S, Tajima F, Yokota A, Hashimoto M, Brengelman GL. Independence of brain and tympanic temperatures in an unanesthetized human.J Appl Physiol (1985), 1988; 65 (1):482-6. https://pubmed.ncbi.nlm.nih.gov/3403491/ Hales JRS. Thermal Physiology. S:377-380, RavenPress, New York, 1984. Strout CD, Nahrwold ML. Halothane requirement during pregnancy and lactation in rats. Anesthesiology, 1981; 55 (3):322-3. https://pubmed.ncbi.nlm.nih.gov/7270956/ McLeod GA. Density of spinalanaestheticsolutions ofbupivacaine, levobupivacaine, and ropivacaine with and without dextrose. Br J Anaesth,2004; 92 (4):547-51. https://pubmed.ncbi.nlm.nih.gov/14766715/ Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5588869","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":448195733,"identity":"a3cbbc69-b935-40ec-9b8a-3f6e4d54cf91","order_by":0,"name":"Azra 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Clinic","correspondingAuthor":false,"prefix":"","firstName":"Melek","middleName":"","lastName":"Doganci","suffix":""},{"id":448195740,"identity":"264dcf75-6f1c-4b7d-91c2-c1a6f8ba984e","order_by":7,"name":"Abdullah Kahraman","email":"","orcid":"","institution":"Ministry of Health Ankara Etlik City Hospital, Anesthesiology and Reanimation Intensive Care Unit","correspondingAuthor":false,"prefix":"","firstName":"Abdullah","middleName":"","lastName":"Kahraman","suffix":""},{"id":448195741,"identity":"0deeefb1-7812-4978-af29-8506977dc55a","order_by":8,"name":"Oral Mentes","email":"","orcid":"","institution":"Health Sciences University, Gulhane Faculty of Medicine, Gulhane Training and Research Hospital, Intensive Care Unit","correspondingAuthor":false,"prefix":"","firstName":"Oral","middleName":"","lastName":"Mentes","suffix":""},{"id":448195742,"identity":"afb8611b-772c-4676-b565-de6d4e43172d","order_by":9,"name":"Yasemin Dayican","email":"","orcid":"","institution":"Ministry of Health Ankara Etlik City Hospital, Anesthesiology and Reanimation Intensive Care Unit","correspondingAuthor":false,"prefix":"","firstName":"Yasemin","middleName":"","lastName":"Dayican","suffix":""}],"badges":[],"createdAt":"2024-12-05 17:53:23","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5588869/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5588869/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12871-025-03148-1","type":"published","date":"2025-05-29T15:56:57+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":82042888,"identity":"62678f64-3489-4add-8781-d03fb4b34db0","added_by":"auto","created_at":"2025-05-06 09:22:57","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":34796,"visible":true,"origin":"","legend":"\u003cp\u003eStudy Design\u003c/p\u003e","description":"","filename":"Fig1.png","url":"https://assets-eu.researchsquare.com/files/rs-5588869/v1/fdbf74cee6dca3d9b78e5fd6.png"},{"id":82042889,"identity":"ae15c3e6-e44a-415b-88ab-4691e39b0e5c","added_by":"auto","created_at":"2025-05-06 09:22:57","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":85829,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eComparison of Tympanic and Leg Temperature Changes Between Groups\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"Fig2.png","url":"https://assets-eu.researchsquare.com/files/rs-5588869/v1/bb1b58409592601e8433a79b.png"},{"id":83782824,"identity":"03a04c46-06a3-4eb3-bd02-350f3b6e3707","added_by":"auto","created_at":"2025-06-02 16:07:08","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1115068,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5588869/v1/6ecb3ad1-fe69-4350-a19d-7d3565690585.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eComparison of The Effects of Two Different Local Anesthetics Used in Spinal Anesthesia on Peripheral and Central Temperature Change: A Randomized Controlled Trial\u003c/p\u003e","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eSpinal anesthesia is widely accepted today as a safe method used in many operations, especially in lower abdominal and extremity surgeries. Recent meta-analyses have further confirm edits safety profile, even in high-risk populations such as elderly patients undergoing hip fracture repair, though careful monitoring of hemodynamic changes remains essential.Moreover,the safety and effectiveness of spinal anesthesia depend on the correct selection and appropriate use of local anesthetics\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e.It is not widely known that spinal anesthesia causes fluctuations in body temperature as much as, or even more than, general anesthesia. There is a lot of literature showing that the temperature decrease in regional anesthesia is similar or even greater than in general anesthesia\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e,\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e.Much of thelack of knowledge about hypothermia during regional anesthesia could be based on thelack of monitoring in these patients. It could serve as a justification to carry out clinical trials in patients under regional anesthesia\u003csup\u003e\u003cspan additionalcitationids=\"CR5 CR6\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e.In patients undergoing spinal or epidural anesthesia, as in general anesthesia, the primary cause of hypothermia is the redistribution of body heat. Neuroaxial anesthesia centrally inhibits thermoregulatory control but has a much more significant effect by blocking peripheral and motor nerves that prevent thermoregulatory vasoconstriction and shivering \u003csup\u003e\u003cspan additionalcitationids=\"CR9 CR10 CR11 CR12\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e. The redistribution that continues during neuroaxial anesthesia is typically limited to the legs. The weight of the legs far exceeds that of the arms and thus contributes much more significantly to redistribution \u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eIsobaric levobupivacaine and hyperbaric bupivacaine are agents frequently used in spinal anesthesia. Comparative studies have been conducted with various doses in many types of operations \u003csup\u003e\u003cspan additionalcitationids=\"CR16\" citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e. Although there are numerous in vitro studies showing changes in local anesthetic densities at different temperatures, we found very few studies demonstrating the clinical effects of these changes \u003csup\u003e\u003cspan additionalcitationids=\"CR20 CR21 CR22\" citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e. The effect of temperature is particularly pronounced in diluent solutions; for example, 0.5% bupivacaine and levobupivacaine are slightly hyperbaric at room temperature (20\u0026ndash;24\u0026deg;C) and slightly hypobaric at body temperature (30\u0026ndash;37\u0026deg;C) \u003csup\u003e\u003cspan additionalcitationids=\"CR24\" citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u003c/sup\u003e. Therefore, these changes in baricity lead to variations in the spread of local anesthetics within the cerebrospinal fluid (CSF) and affect the level of motor and sensory block.\u003c/p\u003e \u003cp\u003ePrevious comparative studies have been conducted on the effects of regional and general anesthesia on core and skin temperatures. However, we did not find any studies comparing the effects of local anesthetics with different baricities on body temperatures. In this study, we aimed to compare the effects of two local anesthetics with different baricities, hyperbaric bupivacaine and isobaric levobupivacaine, on central and peripheral body temperatures in patients undergoing spinal anesthesia and the potential influence of the baricity of the local anesthetic in decreasing the extent of the blockade of the sympathetic nervous system and thus decreasing the extent of the vasodilation caused.\u003c/p\u003e"},{"header":"MATERIALS AND METHODS","content":"\u003cp\u003eAfter obtaining approval from the Fatih University Faculty of Medicine Ethics Committee, at 21.02.2014 with code number 33/5, our study was comply with the principles of the Declaration of Helsinki \u0026nbsp; and conducted on 40 full-term pregnant women aged 18-40, classified as ASA I-II, who were scheduled for elective cesarean sections under spinal anesthesia. All patients included in the study were informed and gave their written and verbal consent 2 hours before the surgery.\u003c/p\u003e\n\u003cp\u003eOur study was planned as a mono centric, prospective, randomized,double-blind trial. A computer-generated random sequence was used for allocation. The groups were divided into the bupivacaine group (Group B) and the levobupivacaine group (Group L)\u0026nbsp;(Figure 1).\u0026nbsp;Neither the physician nor the patient knew which group they are in. Another physician enrolled participants, and who assigned participants to interventions.\u003c/p\u003e\n\u003cp\u003eExclusion criteria were patients for whom spinal anesthesia was contraindicated, those with neuromuscular diseases, alcohol and substance abusers, patients with a body mass index (BMI) \u0026lt;18.5 kg/m\u0026sup2; or \u0026gt;35 kg/m\u0026sup2;, those using medications that could affect thermoregulation such as vasodilators, patients with thyroid disorders, those with fever and infection, and expectant mothers known to have allergies to the study drugs.\u003c/p\u003e\n\u003cp\u003eFor all patients brought to the operating room, an intravenous line was established using a 22-gauge catheter on the dorsum of the hand, and an infusion of room-temperature Ringer\u0026apos;s lactate at 10 ml/kg was initiated to be administered over half an hour before spinal anesthesia. The operating room temperature was maintained at a constant 24\u0026deg;C, monitored by an electronic temperature monitor. Blood pressure was monitored using a non-invasive automatic sphygmomanometer, heart rhythm was monitored with a five-lead electrocardiogram (ECG), and peripheral oxygen saturation was monitored with a pulse oximeter. Temperature probes (Philips temperature probes, Biyoplus Medical TM, Yalova) attached to the lower medial parts of the same side\u0026apos;s lower and upper extremities were used to measure peripheral body temperature, and a tympanic thermometer (Covidien GeniusTM 2, USA) was used to measure central body temperature. All patients\u0026apos; external auditory canals were examined using an otoscope (Rieste, Tuttlingen, Germany), and any cerumen was removed by an ear, nose, and throat specialist. Demographic data (age, weight, height) of all expectant mothers were recorded before the block. Baseline values for mean arterial pressure (MAP), heart rate (HR), oxygen saturation (SpO2), lower and upper extremity temperatures, and tympanic membrane temperature were recorded before anesthesia.\u003c/p\u003e\n\u003cp\u003eThe application was performed by a different physician, and the follow-up was conducted by another physician unaware of the application. All patients were positioned sitting. The puncture site was disinfected with a 10% povidone-iodine antiseptic solution and covered with a sterile drape. Using a 27-gauge Whitacre pencil point spinal needle (B.BraunMelsungen A.G., Germany), the spinal space was accessed through the L3-L4 or L4-L5 interspinous space, and after observing the free flow of cerebrospinal fluid (CSF), 2-2.5 ml of room-temperature hyperbaric 0.5% bupivacaine (15 ml,75 mg) (10-12,5 mg) \u0026nbsp;(Marcaine\u0026reg; spinal heavy, 0.5%, Astra Zeneca, Istanbul) was administered to the bupivacaine group (Group B), and 2-2.5ml (10-12,5 mg) of room-temperature 0.5% levobupivacaine (15 ml, 75 mg) (Chirocaine\u0026reg;, 0.5%, Abbott Laboratories, Istanbul) was administered to the levobupivacaine group (Group L). After the procedure, patients were positioned 15\u0026deg; supine on the left side and 30\u0026deg; head-up.\u003c/p\u003e\n\u003cp\u003eSensory block was determined bilaterally using the pinprick test along the midclavicular line. The sensory block level of the patient was measured and recorded from the 3rd minute after spinal anesthesia. Once it was confirmed that an adequate block level for the operation was achieved, surgery was allowed to proceed. The patient\u0026apos;s MAP, HR, SpO2, tympanic temperature, and peripheral temperatures from the arm and leg were measured and recorded at baseline, and then at 1, 3, and 5 minutes after anesthesia administration, followed by 5-minute intervals.\u003c/p\u003e\n\u003cp\u003eIn cases of severe hypotension (when MAP fell below 20% of preoperative values), 10 mg of ephedrine was planned to be administered, and in cases of bradycardia (HR values below 20% of preoperative values), 0.5 mg of atropine was to be administered. Patients were asked if they experienced any complaints of cold or shivering. No sedatives, hypnotics, or narcotic drugs were administered to the patients.\u003c/p\u003e\n\u003cp\u003eSample size:\u0026nbsp;The power analysis conducted using the means and standard deviations obtained from the results of the study titled \u0026quot;The effect of bupivacaine with fentanyl temperature on initiation and maintenance of labor epidural analgesia: a randomized controlled study\u0026quot; indicated that, with a power of 80% and a significance level of 0.05, a minimum of 24 patients would need to be included in each group\u003csup\u003e26\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical Analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll statistical calculations were performed using SPSS for Windows software (Statistical Package for the Social Sciences), version 20 (SPSS Inc., Chicago, IL, USA). Parameters following a normal distribution were analyzed using the Student\u0026apos;s t-test, while parameters not following a normal distribution were analyzed using the Mann-Whitney U test. The Friedman test was used for the comparison of variables within groups, and the Wilcoxon test was used for multiple comparisons after Bonferroni correction. Values are presented in the article, tables, and graphs as mean \u0026plusmn; standard deviation (SD) or median (25th-75th percentiles). A p-value of \u0026lt;0.05 was considered statistically significant.\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003eA total of 40 female patients scheduled for elective cesarean operations were included in our study. One patient from Group L was excluded due to data loss in temperature monitoring. The study was completed with 20 patients in Group B and 19 patients in Group L.\u003c/p\u003e\n\u003cp\u003eWhen comparing the groups in terms of age, height, weight, operation duration, and the dose of drugs used for spinal anesthesia, no statistically significant differences were found (p \u0026gt;0.05) (Table 1).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1.\u003c/strong\u003e Demographic Data\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"422\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGroup B\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(n= 20)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGroup L\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(n= 19)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 139px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge (Year)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e29.3\u0026plusmn;5.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; 31.0\u0026plusmn;3.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e0.220\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 139px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eHeight (cm)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e164.6\u0026plusmn;5.8\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 164.5\u0026plusmn;6.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.949\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 139px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWeight (kg)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e76.0\u0026plusmn;7.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e78.0\u0026plusmn;8.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.443\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 139px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDuration of operation(minute)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e29.2\u0026plusmn;8.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e25.0\u0026plusmn;7.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.105\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 139px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDose of Drug administered (ml)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e2.4\u0026plusmn;0.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e2.5\u0026plusmn;0.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.054\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.054\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 422px;\"\u003e\n \u003cp\u003ea: Student\u0026rsquo;st-test\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eNo statistically significant differences were found in the comparison of HR, SpO2, and MAP between the groups (p \u0026gt; 0.05). In the intergroup comparisons of MAP measurements, a significant difference was only found in the basal values (p = 0.024).\u003c/p\u003e\n\u003cp\u003eIn Group B, a decrease in tympanic temperature at the 3rd minute and an increase in leg skin temperature at the 5th minute compared to basal values were observed, which was considered statistically significant (p \u0026lt; 0.05) (Table 2).\u003c/p\u003e\n\u003cp\u003eIn Group L, a decrease in tympanic temperature at the 5th minute and an increase in leg skin temperature at the 3rd minute compared to basal values were detected. This was considered statistically significant (p \u0026lt; 0.05) (Table 2).\u003c/p\u003e\n\u003cp\u003eIn both groups, the decrease in tympanic temperature and the increase in leg temperature continued at all time points compared to the baseline in within-group comparisons, and these changes were considered statistically significant (p \u0026lt; 0.05).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eTable 2.\u003c/strong\u003e Within-Group Comparison of Tympanic and Leg Temperature in Group B and Group L\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"572\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 250px;\"\u003e\n \u003cp\u003eGroup B\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 257px;\"\u003e\n \u003cp\u003eGroup L\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTympanic temperature\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLeg temperature\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTympanic temperature\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 46px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLeg temperature\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003ep\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBaseline\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e36.4 \u0026plusmn;0.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e29.5\u0026plusmn;1.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e36.4\u0026plusmn;0.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 46px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e28.9\u0026plusmn;1.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e1\u003csup\u003est\u003c/sup\u003e minute\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e36.3\u0026plusmn;0.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.186\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e29.0\u0026plusmn;2.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e0.175\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e36.4\u0026plusmn;0.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 46px;\"\u003e\n \u003cp\u003e0.938\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e29.2\u0026plusmn;1.57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.152\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e3\u003csup\u003erd\u003c/sup\u003e minute\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e36.1\u0026plusmn;0.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.003\u003csup\u003ea\u003c/sup\u003e*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e29.8\u0026plusmn;1.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e0.380\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e36.3\u0026plusmn;0.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 46px;\"\u003e\n \u003cp\u003e0.129\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e29.4\u0026plusmn;1.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.036\u003csup\u003ea\u003c/sup\u003e*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e5\u003csup\u003eth\u003c/sup\u003e minute\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e36.07\u0026plusmn;0.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.044\u003csup\u003ea\u003c/sup\u003e*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e30.4\u0026plusmn;1.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e0.001\u003csup\u003ea\u003c/sup\u003e*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e36.1\u0026plusmn;0.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 46px;\"\u003e\n \u003cp\u003e0.004\u003csup\u003ea\u003c/sup\u003e*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e30.2\u0026plusmn;1.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.001\u003csup\u003ea\u003c/sup\u003e*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e10\u003csup\u003eth\u003c/sup\u003e minute\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e35.9\u0026plusmn;0.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.001\u003csup\u003ea\u003c/sup\u003e*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e31.5\u0026plusmn;1.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e0.001\u003csup\u003ea\u003c/sup\u003e*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e35.8\u0026plusmn;0.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 46px;\"\u003e\n \u003cp\u003e0.001\u003csup\u003ea\u003c/sup\u003e*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e31.1\u0026plusmn;1.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.001\u003csup\u003ea\u003c/sup\u003e*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e15\u003csup\u003eth\u003c/sup\u003e minute\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e35.8\u0026plusmn;0.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.001\u003csup\u003ea\u003c/sup\u003e*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e32.2\u0026plusmn;1.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e0.001\u003csup\u003ea\u003c/sup\u003e*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e35.7\u0026plusmn;0.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 46px;\"\u003e\n \u003cp\u003e0.001\u003csup\u003ea\u003c/sup\u003e*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e31.8\u0026plusmn;1.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.001\u003csup\u003ea\u003c/sup\u003e*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e20\u003csup\u003eth\u003c/sup\u003e minute\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e35.7\u0026plusmn;0.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.001\u003csup\u003ea\u003c/sup\u003e*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e32.3\u0026plusmn;1.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e0.001\u003csup\u003ea\u003c/sup\u003e*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e35.7\u0026plusmn;0.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 46px;\"\u003e\n \u003cp\u003e0.001\u003csup\u003ea\u003c/sup\u003e*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e32.2\u0026plusmn;1.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.001\u003csup\u003ea\u003c/sup\u003e*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e25\u003csup\u003eth\u003c/sup\u003e minute\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e35.4\u0026plusmn;0.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.001\u003csup\u003ea\u003c/sup\u003e*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e31.8\u0026plusmn;3.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e0.002\u003csup\u003ea\u003c/sup\u003e*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e35.6\u0026plusmn;0.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 46px;\"\u003e\n \u003cp\u003e0.001\u003csup\u003ea\u003c/sup\u003e*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e32.6\u0026plusmn;1.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.001\u003csup\u003ea\u003c/sup\u003e*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e30\u003csup\u003eth\u003c/sup\u003e minute\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e35.3\u0026plusmn;0.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.007\u003csup\u003ea\u003c/sup\u003e*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e32.9\u0026plusmn;1.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e0.005\u003csup\u003ea\u003c/sup\u003e*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e35.8\u0026plusmn;0.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 46px;\"\u003e\n \u003cp\u003e0.009\u003csup\u003ea\u003c/sup\u003e*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e33.3\u0026plusmn;0.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.002\u003csup\u003ea\u003c/sup\u003e*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"9\" valign=\"top\" style=\"width: 572px;\"\u003e\n \u003cp\u003ea: Student\u0026rsquo;s t-test\u003c/p\u003e\n \u003cp\u003eData are presented as mean \u0026plusmn; SD.\u003c/p\u003e\n \u003cp\u003e*p \u0026lt; 0.05 was considered statistically significant.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eWhen comparing the tympanic, leg, and arm temperature measurements of Groups B and L, no statistically significant differences were observed (p \u0026gt; 0.05).\u003c/p\u003e\n\u003cp\u003eWhen comparing the maximum changes in leg skin temperature and tympanic temperature at the 5th minute and subsequent times, no statistically significant differences were observed between the groups (p \u0026gt; 0.05) (Table 3, Figure 2).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3.\u0026nbsp;\u003c/strong\u003eComparison of Tympanic and Leg Temperature Changes Between Groups\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 212px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGroup B\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(n= 20)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGroup L\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(n= 19)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 212px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eChange in leg skin temperature\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;at the 5\u003csup\u003eth\u003c/sup\u003e minute\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.8 (-1.5\u0026ndash;3.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1.3 (-0.8\u0026ndash;3.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.167\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 212px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMaximum change in leg skin temperature\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e3.6 (0.2 \u0026ndash;6.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e3.8 (1.7 \u0026ndash;6.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.771\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 212px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eChange in tympanic temperature\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;at the 5\u003csup\u003eth\u003c/sup\u003e minute\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e-0.4 (-1.1 \u0026ndash;0.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e-0.3 (-1.4 \u0026ndash;0.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e0.708\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 212px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMaximum change in tympanic temperature\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e-0.8 (-1.3 \u0026ndash;-0.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e-1.1 (-1.8 \u0026ndash;-0.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e0.113\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 511px;\"\u003e\n \u003cp\u003eb :Mann- Whitney U Test\u003c/p\u003e\n \u003cp\u003eData are presented as median (min-max).\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;No statistically significant differences were observed in the within-group comparison of arm skin temperatures in both groups (p \u0026gt; 0.05) (Table 4).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4.\u003c/strong\u003eComparison of ArmTemperature Changes Between Groups\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGroup B\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(n= 20)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGroup L\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(n= 19)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBaseline\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003e33.0 \u0026plusmn;1.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e32.7 \u0026plusmn;1.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e0.579\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e1\u003csup\u003est\u003c/sup\u003e minute\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003e32.8\u0026plusmn;1.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e33.06\u0026plusmn;1.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e0.687\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e3\u003csup\u003erd\u003c/sup\u003e minute\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003e32.5\u0026plusmn;1.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e32.6\u0026plusmn;1.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e0.794\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e5\u003csup\u003eth\u003c/sup\u003e minute\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003e32.3\u0026plusmn;1.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e32.6\u0026plusmn;1.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e0.654\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e10\u003csup\u003eth\u003c/sup\u003e minute\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003e32.6\u0026plusmn;1.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e32.8\u0026plusmn;1.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e0.736\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e15\u003csup\u003eth\u003c/sup\u003e minute\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003e32.6\u0026plusmn;1.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e32.9\u0026plusmn;1.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e0.573\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e20\u003csup\u003eth\u003c/sup\u003e minute\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003e32.9\u0026plusmn;1.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e32.9\u0026plusmn;1.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e0.862\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e25\u003csup\u003eth\u003c/sup\u003e minute\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003e32.8\u0026plusmn;1.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e32.9\u0026plusmn;1.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e0.893\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e30\u003csup\u003eth\u003c/sup\u003e minute\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003e32.6\u0026plusmn;1.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e33.7\u0026plusmn;1.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e0,236\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e35\u003csup\u003eth\u003c/sup\u003e minute\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003e32.7\u0026plusmn;2.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e34.7\u0026plusmn;0,2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e0,214\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 440px;\"\u003e\n \u003cp\u003ea: Student\u0026rsquo;s t-test\u003c/p\u003e\n \u003cp\u003eData are presented as mean \u0026plusmn; SD\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eIn the comparison between groups, Group L was found to have a higher maximum sensory block level and a shorter time to reach maximum sensory block (p \u0026lt; 0.05).(Table 5).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 5.\u0026nbsp;\u003c/strong\u003eComparison of Sensory Block Characteristics Between Groups\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eGroup B\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(n= 20)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eGroup L\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(n= 19)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 302px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMaximum Sensory\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eBlock Level\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e4(3\u0026ndash;6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e3(3\u0026ndash;3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e0.007\u003csup\u003eb\u003c/sup\u003e*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 302px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTime to Reach Maximum\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eSensory \u0026nbsp;Level (min)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e7.5(3\u0026ndash;20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e5(5\u0026ndash;5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.015\u003csup\u003eb\u003c/sup\u003e*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 581px;\"\u003e\n \u003cp\u003eb : Mann-Whitney U Test\u003c/p\u003e\n \u003cp\u003eData are presented as median (min-max).\u003c/p\u003e\n \u003cp\u003e*p \u0026lt; 0.05 was considered statistically significant.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eDuring the procedure, hypotension developed in 10 patients in Group B and 11 patients in Group L, while bradycardia developed in 2 patients in Group B and 1 patient in Group L, and these were treated. None of the patients experienced coldness or shivering.\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eHypothermia can frequently occur during regional anesthesia and can be almost as severe as in general anesthesia. As in general anesthesia, the primary cause of hypothermia in patients undergoing spinal or epidural anesthesia is the redistribution of body heat.\u003c/p\u003e\n\u003cp\u003eFrank et al. investigated the causes of hypothermia in patients undergoing spinal anesthesia and found that vasomotor inhibition following spinal anesthesia resulted in blood pooling in peripheral tissues, leading to heat loss and hypothermia\u003csup\u003e25\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eHypothermia occurs less frequently in regional anesthesia compared to general anesthesia. This may be due to the preservation of metabolic rate and vasoconstriction in the arms \u003csup\u003e14\u003c/sup\u003e. Matsukawa et al. evaluated heat redistribution under epidural anesthesia at a constant ambient temperature in 12 male volunteers. The initial hypothermia in the first hour following epidural anesthesia was mainly due to the redistribution of body heat from the internal thermal compartment to the distal legs, and it continued throughout the three-hour duration of anesthesia. It was shown that the arm heat content decreased three times more than the baseline in the three hours following epidural anesthesia. Despite the higher fractional contribution of redistribution in epidural anesthesia, it was noted that internal metabolic heat was preserved and vasoconstriction occurred in the arms, leading to less frequent temperature drops compared to general anesthesia \u003csup\u003e14\u003c/sup\u003e. In our study, the maximum decrease in tympanic temperature was -0.8 (-1.3 to -0.1)\u0026deg;C in the bupivacaine group and -1.1 (-1.8 to -0.2)\u0026deg;C in the levobupivacaine group, consistent with these studies. However, unlike the above study and their findings, the arm temperature values in our patients did not change compared to baseline.\u003c/p\u003e\n\u003cp\u003eIn contrast to these studies, other studies have shown that epidural anesthesia causes a higher rate of hypothermia compared to general anesthesia \u003csup\u003e27,28\u003c/sup\u003e. In a study conducted on 15 patients undergoing transvesical prostatectomy with epidural and standard general anesthesia, internal and superficial temperatures were measured before, during, and for the first 6 hours postoperatively. It was found that total and mean body temperatures dropped more rapidly in the epidural group, with statistically significant differences in the early postoperative period. In another study comparing the effects of lumbar epidural and general anesthesia on body temperatures, it was shown that the temperature drop was slower and shorter in the epidural anesthesia group, while it was faster and lasted longer in the general anesthesia group. Consequently, the number of patients with core temperatures below 35\u0026deg;C was higher in those receiving general anesthesia compared to those receiving epidural anesthesia. In our study, since the operation lasted less than an hour and postoperative temperature monitoring was not performed, we could not evaluate temperature changes in the later hours.\u003c/p\u003e\n\u003cp\u003eIn a study by Hopf et al. involving 53 patients undergoing high thoracic, mid-thoracic, and lumbar epidural anesthesia, bupivacaine and saline of the same volume were administered to each group to evaluate arm and leg temperatures. In the high thoracic application, it was found that temperature increased in the arms and legs of the bupivacaine group and decreased in the saline group. In the mid-thoracic injection, a significant increase in leg temperature was observed, with no change in the arms. Following lumbar injection, a significant increase in leg temperature and a decrease in arm temperature were observed. This supports the hypothesis of vasoconstriction occurring in the arms. While leg temperature changes were similar after high and mid-thoracic injections, the increase in leg temperature following lumbar injection was greater than that observed from the other two regions. This was attributed to sympathetic blockade related to the dermatomes involved. Skin temperature on the body either remained unchanged or significantly decreased in blocked areas. Assuming that increased leg temperature reflects decreased sympathetic activity, it was concluded that high and mid-thoracic segmental epidural anesthesia involving several dermatomes led to sympathetic blockade that included the most caudal part of the sympathetic nervous system. \u003csup\u003e13\u003c/sup\u003e. In our study, following spinal anesthesia, within-group comparisons showed that all measurements over time revealed a continued decrease in tympanic temperature and an increase in leg temperature compared to baseline. The maximum change in leg skin temperature increased by +3.6 (+0.2 \u0026ndash; +6.6)\u0026deg;C in the bupivacaine group and by +3.8 (+1.7 \u0026ndash; +6.7)\u0026deg;C in the levobupivacaine group, with no statistically significant difference observed between the groups.\u003c/p\u003e\n\u003cp\u003eUnlike the studies mentioned above, no difference was detected in arm temperature measurements compared to baseline in our study. This could be due to the numerous factors affecting hypothermia andas well as the fact that our patients were term pregnant.\u003c/p\u003e\n\u003cp\u003eIn a large randomized study by Frank et al. investigating the effects of ambient temperature on hypothermia, 97 patients undergoing lower extremity vascular surgery with general and epidural anesthesia were included. It was observed that there was a significant relationship between operating room ambient temperature and type of anesthesia, with greater body temperature drops occurring with general anesthesia in the cold ambient temperature, but similar drops in warm ambient temperature with both general and epidural anesthesia \u003csup\u003e29\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eSome studies have shown that hypothermia is also related to the patient\u0026apos;s thermal condition and can be corrected by warming the skin before anesthesia induction. It was found that the drop in core temperature during epidural anesthesia was less in the warmed group. As a result, it was shown that preoperative warming reduced redistribution hypothermia during epidural block \u003csup\u003e29\u003c/sup\u003e. In our study, to eliminate the effects of ambient temperature, the operating room temperature was kept constant at 24\u0026deg;C for all patients. Additionally, 10 ml/kg of room-temperature Ringer\u0026apos;s lactate was administered intravenously over half an hour before spinal anesthesia to minimize related changes.\u003c/p\u003e\n\u003cp\u003eIn a study by Goktuğ et al. on patients undergoing inguinal hernia surgery with spinal anesthesia, bupivacaine and levobupivacaine were compared in terms of blood pressure, pulse, motor block status, sensory block level, VAS values, and side effects. The onset time of sensory block was found to be significantly shorter in the levobupivacaine group compared to the bupivacaine group. When examining hemodynamic changes, no significant difference was found between the two groups \u003csup\u003e31\u003c/sup\u003e. In our study, the hemodynamic data, sensory and motor block onset times, and characteristics evaluated during the operation were consistent with other studies \u003csup\u003e16-18\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eEsophageal temperature measurement is known to be the safest method for monitoring core temperature. Studies have shown that under stable conditions, there is a significant correlation between tympanic and esophageal temperatures \u003csup\u003e32-34\u003c/sup\u003e. In our study, we did not prefer esophageal temperature measurement for patients undergoing regional anesthesia, considering it to be invasive. Instead, we used tympanic membrane temperature measurement for core temperature monitoring. For peripheral temperature measurements, we used the forearm and calf temperatures. Due to the effect of subcutaneous fat tissue on heat distribution, we did not include patients who were very thin (body mass index \u0026lt; 18.5 kg/m\u0026sup2;) or very obese (body mass index \u0026gt; 35 kg/m\u0026sup2;) in our study. There was no significant difference between the two groups in terms of height, weight, and body mass index.\u003c/p\u003e\n\u003cp\u003ePregnancy is known to alter both the normal thermoregulatory response and the anesthetic response \u003csup\u003e34-36\u003c/sup\u003e. Only term pregnant patients were included in our study, so changes due to pregnancy were applicable to both groups.\u003c/p\u003e\n\u003cp\u003eWhile there are in vitro studies demonstrating changes in the density of local anesthetics at different temperatures, we found few studies demonstrating the clinical effects of these changes \u003csup\u003e19-23\u003c/sup\u003e. McLeod used the mechanical oscillation resonance method to investigate the relationship between temperature and density, showing that densities at 37\u0026deg;C (0.99944 for 0.5% bupivacaine, 1.00024 for 0.5% levobupivacaine, and 0.99953 mg/mL for 0.5% ropivacaine) were lower than those at 23\u0026deg;C \u003csup\u003e37\u003c/sup\u003e. The effect of temperature is particularly pronounced in diluent solutions; for example, 0.5% bupivacaine and levobupivacaine are slightly hyperbaric at room temperature (20-24\u0026deg;C) and slightly hypobaric at body temperature (30-37\u0026deg;C) \u003csup\u003e23,24\u003c/sup\u003e. In light of these studies, we can say that the local anesthetic drugs we used were slightly hypobaric instead of hyperbaric and isobaric at body temperature, affecting core body temperature in the same direction as baricity.\u003c/p\u003e\n\u003cp\u003eThe limitations of our study include not calculating the basal temperature of the patients, absence of esophageal thermometer, not performing postoperative temperature monitoring and being a monocentric study.While all of the patients were pregnant, the study was carried out on women and there fore the application of the findings is not extensible too ther populations such as men, children or the elderly.The last limitation of our prospective study is conducted in 2014, did not receive a Clinical Trial Number, as it was not obtained at that time.\u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eIn conclusion, in our study evaluating central and peripheral temperatures following spinal anesthesia with isobaric levobupivacaine and hyperbaric bupivacaine, there was no difference between the groups in terms of the maximum increase in peripheral temperature and the level of central temperature decrease. However, much of the lack of knowledge about hypothermia during regional anesthesia could be based on the lack of monitoring in these patients. It could serve as a justification to carry out clinical trials in patients under regional anesthesia.We believe that adequate monitoring and precautions should be taken to avoid hypothermia, especially in long surgeries and at-risk groups, following spinal anesthesia.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics Approval And Consent To Participate:\u0026nbsp;\u003c/strong\u003eEthical approval for this study (decision number:33/5) \u0026nbsp;was provided by the Ethical Committee Turgut Ozal University Hospital, Ankara, Turkey \u0026nbsp;on 21 February 2014.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent For Publication:\u0026nbsp;\u003c/strong\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of Data and Materials:\u0026nbsp;\u003c/strong\u003eThe data sets used and/or analysed during the current study available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflicts of Interest:\u003c/strong\u003e The authors have declared that no competing interests exist.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u0026nbsp;\u003c/strong\u003eThis study \u0026nbsp; received \u0026nbsp; \u0026nbsp;no \u0026nbsp; grant \u0026nbsp; from \u0026nbsp; \u0026nbsp;any \u0026nbsp; funding \u0026nbsp; agency \u0026nbsp; \u0026nbsp;in \u0026nbsp; the public, \u0026nbsp; commercial, \u0026nbsp; \u0026nbsp;or \u0026nbsp; not-for-profit \u0026nbsp; sectors. The authors have declared that no competing interests exist.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; Contributions:\u0026nbsp;\u003c/strong\u003eA.O, G.E.D, M.D conception or design of the work; A.K.,O.M., Y.D \u0026nbsp;acquisition, analysis, interpretation of data; H.K.,B.M.,Se.K.,Sa.K. \u0026nbsp; interpretation of data; A.O., G.E.D drafting the work and reviewing.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments:\u0026nbsp;\u003c/strong\u003eWe would like to thank R\u0026uuml;veyda İrem Demircioğlu, MD. Asist.Prof., Muhammed G\u0026ouml;zdemir, MD. Asist.Prof., Bahadır K\u0026ouml;sem, MD. specialist, who helped collect and evaluate part of data in this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Access Statement:\u003c/strong\u003e All relevant data are within the paper and its Supporting Information files.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompliance with Ethical Standards:\u003c/strong\u003e All the authors mentioned in the manuscript have agreed for authorship, read and approved the manuscript, and given consent for submission and subsequent publication of the manuscript. The manuscript in part or in full has not been submitted or published anywhere.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eMessina A, La Via L, Milani A, Savi M, Calabro L, Sanfilippo F, Negri K, Castellani G, Cammarota G, Robba C, Morenghi E, Astuto M, Cecconi M. 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BMC Anesthesiol, 2014; 14:97. https://pubmed.ncbi.nlm.nih.gov/25371654/\u003c/li\u003e\n \u003cli\u003eMuslu B, Demircioğlu İR Muslu S, Karabayırlı S, Sert H, UstaB.SıcaklıkDeğişikliğininLokalAnestetik/OpioidKarışımıDansitesi\u0026Uuml;zerineEtkisi.TurkJ AnesthReanim, 2012; 40 (5):279-83. https://turkmedline.net/detay/sicaklik-degisikliginin-lokal-anestetik-opioid-karisimi- dansitesi-uzerine-etkisi/a8ec7116206214d0/tr/112%2B2012%2B40%2B5\u003c/li\u003e\n \u003cli\u003eHeller AR, Zimmermann K, Seele K, R\u0026ouml;ssel T, Koch T, Litz RJ. Modifyingthe baricity of local anesthetics for spinal anesthesia by temperatureadjustment: model calculations. Anesthesiology, 2006; 105 (2):346-53. https://pubmed.ncbi.nlm.nih.gov/16871069/\u003c/li\u003e\n \u003cli\u003eStienstraR,GielenM,PoortenF,KroonJW. Spinalanesthesiawithplain bupivacaine 0.5%: regression of sensory and motor blockade withdifferent temperatures of the anesthetic solution. AnesthAnalg, 1989; 69 (5):593-7. https://pubmed.ncbi.nlm.nih.gov/2802194/\u003c/li\u003e\n \u003cli\u003eStienstraR,VanPoortenJF. The temperature of bupivacaine0.5%affectsthe sensory level of spinal anesthesia. AnesthAnalg, 1988; 67 (3):272-6. https://pubmed.ncbi.nlm.nih.gov/3344977/\u003c/li\u003e\n \u003cli\u003eNazliB,OğuzalpH,HorasanliE,GamliM,DikmenB,GogusN. The effect son sensorial block, motor block, and haemodynamics of levobupivacaine atdifferent temperatures applied in the subarachnoid space. Biomed Res Int, 2014;2014: 132687.\u003c/li\u003e\n \u003cli\u003ehttps://pubmed.ncbi.nlm.nih.gov/24772412/\u003c/li\u003e\n \u003cli\u003eCallesen T, Jarnvig I, Thage B, Krantz T, Christiansen C. Influenceof temperature of bupivacaine on spread of spinal analgesia. Anaesthesia, 1991;46 (1):17-9. https://pubmed.ncbi.nlm.nih.gov/1996745/\u003c/li\u003e\n \u003cli\u003eFrank SM, El-Rahmany HK, Cattaneo CG, Barnes RA. Predictors ofhypothermia during spinal anesthesia. Anesthesiology, 2000; 92 (5):1330-4. https://pubmed.ncbi.nlm.nih.gov/10781278/\u003c/li\u003e\n \u003cli\u003eSviggum, H. P., Yacoubian, S., Liu, X., \u0026amp; Tsen, L. C. (2015). The effect of bupivacaine with fentanyl temperature on initiation and maintenance of labor epidural analgesia: a randomized controlled study. International Journal of Obstetric Anesthesia, 24(1), 15-21.\u003c/li\u003e\n \u003cli\u003eHendolin H, Lansimies E. Skin and central temperatures duringcontinuous epidural analgesia and general anaesthesia in patients subjected toopen prostatectomy. Ann Clin Res, 1982; 14 (4):181-6. https://pubmed.ncbi.nlm.nih.gov/7168548/\u003c/li\u003e\n \u003cli\u003eHoldcroftA,HallGM,CooperGM.Redistributionofbodyheatduring anaesthesia. A comparison of halothane, fentanyl and epiduralanaesthesia. Anaesthesia, 1979; 34 (8):758-64. https://pubmed.ncbi.nlm.nih.gov/525732/\u003c/li\u003e\n \u003cli\u003eFrankSM,BeattieC,ChristophersonR,NorrisEJ,RockP,ParkerS, et al. Epidural versus general anesthesia, ambient operating roomtemperature, and patient age as predictors of inadvertent hypothermia. Anesthesiology,1992; 77 (2):252-7. https://pubmed.ncbi.nlm.nih.gov/1642343/\u003c/li\u003e\n \u003cli\u003eGlosten B, Hynson J, Sessler DI, Mc Guire J. Preanesthetic skin-surfacewarming reduces redistribution hypothermia caused by epidural block. AnesthAnalg, 1993; 77 (3):488-93. https://pubmed.ncbi.nlm.nih.gov/8368549/\u003c/li\u003e\n \u003cli\u003eG\u0026ouml;ktuğ A,Takmaz S,Uyar E,Başar H.İnguinal herni operasyonlarında 0.5% bupivakain ile 0.5% levobupivakainin anestezi kalitesi ve hemodinamik parametreler y\u0026ouml;n\u0026uuml;nden karşılaştırılması. TARD dergisi, 2006; 34:254-255. https://akademi.tard.org.tr/?p=bildiri\u0026amp;kID=4370\u0026amp;sec=209833736\u0026amp;session=42219986u126659958s211099931\u003c/li\u003e\n \u003cli\u003eLopez M, Ozaki M, Sessler DI, Valdes M. Mild core hyperthermia does notalter electroencephalographic responses during epidural-enflurane anesthesiain humans. J Clin Anesth, 1993; 5 (5): 425-30. https://pubmed.ncbi.nlm.nih.gov/8217181/\u003c/li\u003e\n \u003cli\u003eCork RC, Vaughan RW, Humphrey LS. Precision and accuracy of intraoperative temperature monitoring. AnesthAnalg, 1983; 62 (2):211-4. https://pubmed.ncbi.nlm.nih.gov/6829923/\u003c/li\u003e\n \u003cli\u003eShiraki K, Sagawa S, Tajima F, Yokota A, Hashimoto M, Brengelman GL. Independence of brain and tympanic temperatures in an unanesthetized human.J Appl Physiol (1985), 1988; 65 (1):482-6. https://pubmed.ncbi.nlm.nih.gov/3403491/\u003c/li\u003e\n \u003cli\u003eHales JRS. Thermal Physiology. S:377-380, RavenPress, New York, 1984.\u003c/li\u003e\n \u003cli\u003eStrout CD, Nahrwold ML. Halothane requirement during pregnancy and lactation in rats. Anesthesiology, 1981; 55 (3):322-3. https://pubmed.ncbi.nlm.nih.gov/7270956/\u003c/li\u003e\n \u003cli\u003eMcLeod GA. Density of spinalanaestheticsolutions ofbupivacaine, levobupivacaine, and ropivacaine with and without dextrose. Br J Anaesth,2004; 92 (4):547-51. https://pubmed.ncbi.nlm.nih.gov/14766715/\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-anesthesiology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bane","sideBox":"Learn more about [BMC Anesthesiology](http://bmcanesthesiol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bane","title":"BMC Anesthesiology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Spinal anesthesia, local anesthetics, thermoregulation, baricity","lastPublishedDoi":"10.21203/rs.3.rs-5588869/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5588869/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eObjective: \u003c/strong\u003eIn this study, we aimed to compare the effects of two different local anesthetics with different baricity used in spinal anesthesia on thermoregulation.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMaterials and Methods: \u003c/strong\u003eOur study was conducted on forty full-term pregnant women scheduled for elective cesarean sections under spinal anesthesia. At an operating room temperature of twenty-four degrees Celsius, peripheral body temperature was measured using temperature probes attached to the lower medial parts of the same side's lower and upper extremities, and central body temperature was measured with a tympanic thermometer. Isobaric levobupivacaine and hyperbaric bupivacaine were used in spinal anesthesia applications. After spinal anesthesia, tympanic temperature, arm and leg temperatures, mean arterial pressure, heart rate, and oxygen saturation were measured and recorded at baseline, the first, third, and fifth minutes, and every five minutes thereafter until the end of surgery.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eIn the bupivacaine group, a decrease in tympanic temperature was observed at the third minute and an increase in leg skin temperature at the fifth minute compared to baseline values. In the levobupivacaine group, a decrease in tympanic temperature was observed at the fifth minute, and an increase in leg skin temperature was observed at the third minute. In both groups, within-group comparisons showed a continued decrease in tympanic temperature and increase in leg temperature at all subsequent time points compared to baseline. No statistically significant difference was observed in arm skin temperatures within groups in either group.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003eWe observed that the effects of hyperbaric bupivacaine and isobaric levobupivacaine used in spinal anesthesia on thermoregulation were similar.\u003c/p\u003e","manuscriptTitle":"Comparison of The Effects of Two Different Local Anesthetics Used in Spinal Anesthesia on Peripheral and Central Temperature Change: A Randomized Controlled Trial","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-05-06 09:22:53","doi":"10.21203/rs.3.rs-5588869/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-05-12T07:10:35+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-05-12T07:08:31+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-05-08T21:49:53+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"16043770477067708366844207657194098337","date":"2025-05-03T08:57:32+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-05-03T05:54:10+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-05-03T05:38:44+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Anesthesiology","date":"2025-04-25T21:06:55+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-anesthesiology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bane","sideBox":"Learn more about [BMC Anesthesiology](http://bmcanesthesiol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bane","title":"BMC Anesthesiology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"5f6f212c-408a-4653-9e3b-652e9ca09c83","owner":[],"postedDate":"May 6th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-06-02T15:59:50+00:00","versionOfRecord":{"articleIdentity":"rs-5588869","link":"https://doi.org/10.1186/s12871-025-03148-1","journal":{"identity":"bmc-anesthesiology","isVorOnly":false,"title":"BMC Anesthesiology"},"publishedOn":"2025-05-29 15:56:57","publishedOnDateReadable":"May 29th, 2025"},"versionCreatedAt":"2025-05-06 09:22:53","video":"","vorDoi":"10.1186/s12871-025-03148-1","vorDoiUrl":"https://doi.org/10.1186/s12871-025-03148-1","workflowStages":[]},"version":"v1","identity":"rs-5588869","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5588869","identity":"rs-5588869","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}