Title: A Prospective, Randomized, Double blinded, Comparative Study of Clonidine and Tramadol for Control of Shivering under Spinal Anesthesia
Authors: Dr Sowmya M Jois, Dr Soumya Rao, Dr Krishna L S, Dr A Sreenivasa Babu
DOI: http://dx.doi.org/10.18535/jmscr/v4i8.37
BACKGROUND: Shivering is a common complication of spinal anesthesia. We compared the efficacy of intravenous clonidine and tramadol for the treatment of shivering under spinal anesthesia. MATERIALS AND METHODS: In this prospective, randomised, double blinded, comparative study, 80 patients coming for lower abdominal and lower limb surgeries under spinal anesthesia were included. Patients were grouped into group C and group T who received clonidine 0.5mcg/kg and tramadol 0.5mg/kg respectively after the onset of shivering. Time of onset of shivering, cessation of shivering after administration of drug, vital signs and side effects were noted. RESULTS: Time of cessation of shivering was shorter in group C compared to group T (2.51±0.66minutes and mean time taken by Tramadol to control shivering was 4.82±0.90 min). Group C had more incidence of decrease in heart rate and blood pressure and higher sedation scores. Group T had higher incidence of nausea and vomiting. CONCLUSION: Our study concludes that both study drugs Clonidine and Tramadol are effective in controlling shivering under spinal anesthesia but clonidine took shorter time to achieve cessation of shivering compared to tramadol. There is a significant improvement in SPO2 values following control of shivering. Clonidine causes decrease in heart rate and systolic blood pressure. The occurrence of bradycardia, hypotension, dry mouth, sedation is higher in clonidine group. The occurrence of nausea and vomiting are higher in Tramadol group compared to clonidine group. Clonidine is safer and effective alternative to Tramadol in controlling shivering in patients receiving spinal anesthesia for surgery. KEYWORDS-spinal, shivering, anesthesia, clonidine, tramadol 1. De Whitte, Sessler DI. Perioperative shivering: Physiology and Pharmac-ology. Anaesthesiology.2002; 96:467–84. 2. Sessler DI, Ponte J. Shivering during epidural anaesthesia. Anesthesiology. 1990; 72:816–21. 3. Sessler DI. Perioperative heat balance. Anaesthesiology. 2000; 92:578-96. 4. Larry J .Crowley, Donal J. Buggy. Shivering and neuraxial anesthesia. Regional anesthesia and pain medicine volume 33 no 3 may- June 2008:241-252. 5. Buggy.D.J and Crossley W.A. Thermoregulation, mild perioperature hypothermia and post-anesthetic shivering. BJA 84(5):615-28 (2000) 6. Bhattacharya P., Bhattacharya L., Jain R., Agarwal R. Post anaesthesia shivering (pas): a review. Indian J. anaesth. 2003; 47 (2) : 88-93 7. Daniel I. Sessler. Temperature Regulation and Monitoring. In: Miller RD, Eriksson IL, Fleisher LA, Wiener-Kronish PJ, Young LW (eds.)Miller’s Anesthesia. 7th ed. Philadelphia: Churchill Livingstone Elsevier; 2010. p 8. Pauca AL, Savage RT, Simpson S Roy RC. Effect of pethidine, fentanyl and morphine on post-operative shivering in man. Acta Anesthesiol Scand 1984; 28(2):138-43. 9. Bansal P, Jain G.Control of shivering with clonidine, butorphanol, and tramadol under spinal anesthesia: a comparative study. Local Reg Anesth. 2011; 4:29-34 10. D. Dal, A. Kose, M. Honca, S. B. Akinci, E. Basgul and U. Aypar; Efficacy of prophylactic ketamine in preventing postoperative shivering BJA 2005; 95(2):189-192 11. Wadhwa A, Sengupta P, Durrani J, Akça O, R Lenhardt, D I Sessler, A G Doufas. Magnesium sulphate only slightly reduces the shivering threshold in humans British Journal of Anaesthesia 2005; 94: 756-762. 12. Powell RM, Buggy DJ. Ondansetron given before induction of anesthesia reduces shivering after general anesthesia. Anesth Analg. 2000; 90:1423–7. 13. Elvan EG, Oc B, Uzun S, Karabulut E, Coşkun F, Aypar U. Dexmedetomidine and postoperative shivering in patients undergoing elective abdominal hysterectomy. Eur J Anaesthesiol. 2008; 25:357-64 14. F. Bilotta,1 F. Ferri,1 F. Giovannini,1 G. Pinto2 and G. Rosa Nefopam or clonidine in the pharmacologic prevention of shivering in patients undergoing conscious sedation for interventional neuroradiology. Anaesthesia, 2005, 60, pages 124–128 15. Wrench IJ, Cavill G, Ward JE, Crossley AW. Comparison between Alfentanil, Pethedine, and placebo in the treatment of postoperative shivering. Br J Anaesth. 1997; 79:541–2. 16. Filos KS, Goudas LC, Patroni O, Polyzou V. Hemodynamic and analgesic profile after intrathecal clonidine in humans. A dose-response study. Anesthesiology. 1994; 81:591–601. 17. Shukla U, Malhotra K, Prabhakar T. A comparative study of the effect of clonidine and tramadol on post-spinal anaesthesia shivering. Indian J Anaesth 2011;55:242-6 18. Wason R, Jain N, Gupta P, Gogia AR. Randomized double-blind comparison of prophylactic ketamine, clonidine and tramadol for the control of shivering under neuraxial anaesthesia. Indian J Anaesth 2012; 56:370-5 19. S. Kulshrestha, R.K. Mehta. Efficacy of Intravenous Clonidine & Tramadol on Post Spinal Anaesthesia Shivering in Elective Lower Segment Caesarean Section: A Randomized Comparative Study. People’s Journal of Scientific Research Vol. 7(1), Jan. 2014Abstract
References