Control of Shivering with Prophylactic Ketamine During Subarachnoid Block: A Placebo-Controlled Randomised Double- Blind Study

Abstract

Introduction: Shivering is a common and challenging side effect of anaesthesia and may result in different degrees of perioperative hypothermia. Hence, the aim of the study was to compare the efficacy of ketamine to prevent shivering during subarachnoid block inpatient undergoing elective surgery. Material and Methods: We conducted a prospective randomized, double-blind placebo-controlled trial with total of 90 ASA I and II patients of either sex between the ages of 18-60 years undergoing elective infra-umbilical surgery under subarachnoid blocks. Random allocation of patients was done into Group1: ketamine at dose of 0.5 mg /kg (n=30), Group2: ketamine at dose of 0.25 mg /kg (n=30), Group3: saline (n=30). Results: The study groups were comparable at the baseline. After spinal anaesthesia and concomitant administration of the study drug, shivering was observed only in 10% of patient with score 1 in Group 1 and Group 2. Whereas in placebo group 50% patients suffered different degrees of shivering and required treatment (p<0.05). After drug injection % of patient had higher sedation score (3 or 2) which was significantly higher in Group 1 (3%) than Groups 2 and 3 (0%) (P=0.002). Only 3.3% patients of group1 experienced hallucination and rest of the patients in any group had no hallucination (P value= 0.045) Conclusion: Ketamine at a dose of 0.5 mg /kg had similar effects as that of ketamine at dose of 0.25 mg /kg when compared to placebo group. However, ketamine at dose of 0.5 mg /kg caused higher effects of sedation and hallucination.

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“…The finding was similar to Seyam et al [16] and Zoengmawia et al [17] where only 14% of the patients had IOSH more than Grade 3 in ketamine group and none among the patients had IOSH more than Grade 3 in ketamine group respectively in either of the studies.…”

“…They found that the IOSH incidence was remarkably lesser in ketamine group (13.79%) when compared with its placebo (58.06%) in patients undergoing elective abdominal and lower limb surgeries under spinal anaesthesia (p<0.001). Seyam et al [16] and Zoengmawia et al [17] compared ketamine as a single IV bolus at a dose of 0.2 mg/kg compared with tramadol and ketamine in two different doses (0.25 mg/kg and 0.5 mg/kg), respectively, with placebo and concluded that the incidence of IOSH was much lesser in ketamine after SA (p<0.05). All these three studies were consistent with the results of this study and proved that the dose of 0.1 mg/kg of ketamine is also effective to control IOSH when compared with higher doses of ketamine as used in these studies.…”

The Effect of Ketamine Versus Tramadol on Prophylactic Post-Spinal Shivering in Those Patients Undergoing Orthopedic Surgery

“…Another research done at the institution civil hospital in Aizawl, Mizoram, found that ketamine significantly reduced core temperature compared to the control group. This may be because spinal anesthetics have a vasodilatory effect (33).…”