Comparative efficacy and safety of intravenous clonidine and tramadol for control of postspinal anesthesia shivering

Abstract

Background:Shivering is a common problem in patients undergoing surgery under spinal anesthesia.Aims:The aim of this study was to compare efficacy and safety of clonidine versus tramadol in postspinal anesthesia shivering.Settings and Design:This prospective, randomized, double-blind controlled clinical trial was conducted in a tertiary care setting.Materials and Methods:A total of 60 American Society of Anesthesiologists physical status Class l and II adult patients (age 18–65 years) undergoing surgery under spinal anesthesia and developed shivering received either clonidine 1 μg/kg or tramadol 1 mg/kg intravenously. The time required for cessation of shivering, control and recurrence rate of shivering, effect on hemodynamics and side effects were compared between two groups.Statistical Analysis:Unpaired t-test and Chi-square test were used for comparison of continuous variables and dichotomous data between two groups, respectively. P < 0.05 was considered as statistically significant.Results:Time for cessation of shivering was less in clonidine group than tramadol group (02.51 vs. 04.82 min; P < 0.001). Complete control of shivering was achieved in 80% of patients in clonidine group versus 70% in tramadol group. There was no significant difference for control (P = 0.5) and rate of recurrence of shivering between clonidine and tramadol group (06.7% vs. 16.7%; P = 0.42). Pulse rate and systolic blood pressure were significantly lower in clonidine group at 5 and 15 min as compared with tramadol. Significantly more number of patients experienced nausea and dizziness (36.7% vs. 0%; P < 0.001 and 20% vs. 0%; P = 0.01) with tramadol while bradycardia and hypotension were numerically more common in patients receiving clonidine (6.7% vs. 0% and 13.3% vs. 0%).Conclusion:Clonidine provides early relief from shivering than tramadol with fewer side effects in patients undergoing surgery under spinal anesthesia.

Comparative assessment of clonidine and tramadol on post-spinal anaesthesia shivering among patients with lower abdominal and lower limb surgeries

“…A large number of studies have been done to assess the role of prophylactic pharmacological intervention for post-spinal anesthesia shivering. Vyas V et al [7] compared efficacy and safety of clonidine versus tramadol in postspinal anesthesia shivering. A total of 60 American Society of Anesthesiologists physical status Class l and II adult patients (age 18-65 years) undergoing surgery under spinal anesthesia and developed shivering received either clonidine 1 μg/kg or tramadol 1 mg/kg intravenously.…”

To Determine Efficacy of Granisetron Versus Placebo for Reducing Shivering in Patients Undergoing Lower Segment Caesarean Section Under Spinal Anaesthesia

“…(Table -III & fig- 1) Incidence of nausea and vomiting recorded to be 9 (10.46%) in group B requiring emesis mangement. venous bolus of tramadol hydrochloride for effective control of shivering and 9 (10.4%) patients presented with complaint of nausea and vomiting which was treated with 10 mg intravenous bolus of metoclopramide 14,15 .…”

Comparison of Dexmedetomidine and Ondansetron for Prevention of Shivering in Lower Limb Surgeries After Spinal Anaesthesia

“…Numerous mechanisms are suggested for its pathogenesis like various non-thermoregulatory and hindrance with thermoregulation. 3 One of the main reason is inhibition of thermoregulatory mechanism by anaesthetics. Vasodilation of skin, uninhibited spinal reflexes and pain are the further proposed mechanisms.…”

“…Various receptors like serotonin, opioid and α2 receptors are also involved. 3 In the recent years, because of increased understanding of adverse effects of shivering, its prevention has become an essential part of anaesthesia care.…”