Dexmedetomidine versus Nefopam for the management of post-spinal anesthesia shivering: A randomized double-blind controlled study

Abstract

Background: This study is designed to evaluate the relative efficacy of intravenously administered dexmedetomidine and nefopam for control of intraoperative shivering following spinal anesthesia. Materials and methods: A prospective, randomized, double-blind, controlled study was conducted on 100 ASA grade I and II patients of either sex, aged 18-60 years, scheduled for elective lower abdominal and lower limb surgeries, under spinal anesthesia. Patients who developed post-spinal anesthesia shivering of grade 3 or 4 were included in the study, and randomly allocated to one of two groups, group D (n = 50), received Dexmedetomidine in a dose of 0.5 lg/kg diluted in 10 ml isotonic saline slowly I.V. (one minute duration), and group N (n = 50), received Nefopam in a dose of 0.15 mg/kg diluted in 10 ml isotonic saline slowly I.V. (one minute duration) when shivering was observed. Time taken for control of shivering, response rate, recurrence rate, hemodynamics, time to first request of rescue analgesic, one-patient cost and adverse effects were recorded. Results: The time taken for control of shivering was statistically significantly shorter in Nefopam group (group N) compared with dexmedetomidine group (group D). The average time taken for disappearance of shivering was 2.35 ± 0.67 min in group N compared with group D (4.63 ± 1.19 min) (p = 0.041). Patients with incomplete response were more in group D (two patients in group D compared with nil in group N), but not statistically significant and recurrence rate was one patient in group D compared with nil in group N. Time to first request to rescue analgesic was significantly prolonged in group N (351.24 ± 19.71 min) compared with group D (192.63 ± 9.08 min). One-patient cost was significantly lesser in group N (about two £/patient) compared with group D (about 168 £/patient). Adverse effects such as bradycardia, hypotension and sedation were observed in Dexmedetomidine group, while pain at injection was noted in Nefopam group. Conclusion: Nefopam is better as compared to dexmedetomidine for control of intraoperative shivering under spinal anesthesia due to its rapid onset, higher response rate, no sedation, lesser hemodynamic alterations, lesser requirements of rescue analgesics and lesser costs.

Pharmacological Interventions for the Treatment and Control of Shivering in Adult Patients Undergoing Elective Surgery Under Regional Anaesthesia: A Systematic Review and Meta-Analysis

“… 6 , 8 , 9 , 10 - 12 Clonidine was used in 3 studies 9 , 12 , 13 and meperidine was used in 2 studies. 7 , 8 Other drugs used were nalbuphine, 6 magnesium sulfate, 5 nefopam, 11 and butorphanol. 13 Saline was used as a control in 3 studies.…”

“…Kaya et al 7 compared meperidine 0.35 mg kg −1 to tramadol 0.25 mg kg −1 (n = 30). The effect on shivering control was quite similar in both drugs: meperidine (93%) and tramadol (90%) ( P = .67 using a 2 sample test for proportion, z test in STATA).…”

“…Ibrahim et al 5 did a double-blinded placebo-controlled trial on 120 patients. In Group P (prophylactic; n = 40) MgSO 4 , 50 mg kg −1 intravenous bolus followed by 2 mg kg −1 h −1 infusion was administered.…”

“…Fern and Misiran 8 reported the comparison of dexmedetomidine 0.5 μg kg −1 , pethidine 0.5 mg kg −1 , and tramadol 0.5 mg kg −1 in 30 patients per group. He reported that tramadol takes less time to abort shivering than meperidine and dexmedetomidine.…”

“…Kundra et al 9 studied the effect of intravenous dexmedetomidine (0.5 μg kg −1 ) with tramadol (0.5 mg kg −1 ) and reported that the time taken for the cessation of shivering was significantly less with dexmedetomidine (2.90 ± 0.23 minutes) than with tramadol (4.61 ± 0.38 minutes) ( P < .001).…”