Randomized controlled, double-blind study to evaluate oral clonidine to prevent post-subarachnoid block shivering in patients undergoing elective urological surgery

Dhorigol, M G; Dhulkhed, Vithal K; Biyani, Alok; Nitish, Desai

doi:10.4103/0970-9185.75098

Cited by 10 publications

(3 citation statements)

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“…Furthermore, 2 meta-analyses showed a significant reduction in the incidence of post-spinal shivering after prophylactic oral or IV administration of clonidine [ 19 , 20 ]. When lower doses (0.15 mg) of oral clonidine premedication were used before spinal anaesthesia for urological surgeries, despite showing significant anti-shivering properties, higher incidence, frequency and severity of shivering than those found in our study were recorded [ 13 , 21 ].…”

Section: Discussionmentioning

confidence: 83%

Effects of oral premedication with tramadol, pregabalin or clonidine on shivering after spinal anaesthesia in patients undergoing hysteroscopic procedures

Gaballah¹,

Abdallah²

2020

ait

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Shivering is a common unpleasant perioperative complication of neuraxial anaesthesia. It has been reported in 40-70% of regionally anaesthetized patients. Shivering is a physiological compensatory response to core hypothermia due to redistribution of heat as a result of vasodilatation from chemical sympathectomy of spinal anaesthesia, exposure to a cool environment, infusion of unwarmed fluids and evaporation from exposed surfaces [1]. During neuraxial anaesthesia, not only is core heat redistributed from the trunk (below the sympathectomy level) to the periphery, but also the thermoregulatory system is significantly impaired due to the inhibited tonic vasoconstriction [2]. Moreover, the shivering threshold is reduced by about 0.5°C during neuraxial anaesthesia [3]. The exposure of the thermosensitive structures within the spinal cord to a cold local anaesthetic is another contributing factor [4].

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Section: Discussionmentioning

confidence: 83%

Effects of oral premedication with tramadol, pregabalin or clonidine on shivering after spinal anaesthesia in patients undergoing hysteroscopic procedures

Gaballah¹,

Abdallah²

2020

ait

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“…Research shows that a number of additional variables, including the anesthetic used, the patient's age and gender, the length of time spent under anesthetic, the kind of surgery performed, the duration of the anesthetic, and the extent of the operation all have a role in determining the occurrence (7). Exacerbation of wound pain, delayed wound healing, increased metabolic demand, increased oxygen consumption, and hemostatic dysfunction might result from untreated PSS, particularly in individuals with limited cardiac reserve and arterial hypoxia (8). Fortunately, there are a number of strategies to treat PSS and many more ways to prevent it from happening (9).…”

Section: Introductionmentioning

confidence: 99%

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

Waheed¹,

Raza²,

Saleh³

et al. 2023

PJMHS

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Background/Objective: Orthopedic patients have a particularly high risk for post-spinal shivering, a typical consequence of spinal anesthesia. Without treatment, shaking may worsen wound pain, increase oxygen use, and impair healing. There have been a number of studies looking at the efficacy of ketamine and other medications for reducing post-spinal shivering. Despite this, there is a dearth of data on more effective and widely available preventive medicines. As a result, the purpose of this research was to evaluate the efficacy of 0.25 mg/kg of Ketamine (K) against 0.5 mg/kg of Tramadol (T) in preventing shivering after spinal anesthesia. Methodology: 200 patients who were to have orthopedic surgery under spinal anesthesia were randomly chosen to participate in this prospective cohort study. Patients who were given a prophylactic dosage of intravenous ketamine prior to spinal anesthesia are referred to as the Ketamine group(n=100), whereas those who were given Tramadol are referred to as the Tramadol group (N=100). During the intraoperative phase, vital signs such as shivering intensity and frequency, blood pressure, heart rate, and axillary body temperature were monitored hourly at 10-minute intervals for a whole hour. Results: There were 87 patients (43%) who had post-spinal shivering; this number was 32 (32%) for those given ketamine and 55(55%) for those given tramadol (p=0.001). With a p-value of 0.000, the incidence of nausea and vomiting was statistically significantly higher in the tramadol group of 82(82%). The ketamine group had significantly more intraoperative sedation than the tramadol group (p 0.007). Conclusion: After spinal anesthesia, low-dose ketamine is more active in lowering the frequency and intensity of shivering. Therefore, we advise patients having orthopedic surgery under spinal anesthesia to take low-dose ketamine beforehand as a preventative measure against post-spinal shivering. Keywords: Ketamine, Tramadol, Shivering, Orthopedic surgery

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“…It has been reported to be 8.15% in sub-Saharan tertiary hospitals and 11.6% in Ethiopia [ 7 , 8 ]. The high incidence of PSS is related to hypothermia, which occurs during the intraoperative period because of vasodilatation and loss of thermoregulatory vasoconstriction below the level of spinal block, which results in heat redistribution from the core to the peripheral body [ 9 ]. Studies show that the incidence is also determined by other factors like the type of anesthesia used, age and gender of the patient, duration of anesthesia and surgery, type of surgery, and orthopedic surgery [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

The effect of ketamine versus tramadol on prophylactic post-spinal shivering in those patients undergoing orthopedic surgery: a prospective cohort study design, 2020

et al. 2022

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Background Post-spinal shivering is a common complication after spinal anesthesia with a high incidence among orthopedic patients. Untreated shivering may predispose to exacerbation of wound pain, increased metabolic demand, oxygen consumption, and hemostatic dysfunction. Various studies have been done on the effectiveness of preventing post-spinal shivering using ketamine and other drugs. However, little information on better prophylactic agents in terms of effectiveness and availability. Therefore, this study was intended to compare 0.25 mg/kg of Ketamine (K) versus 0.5 mg/kg of Tramadol (T) for the prevention of post-spinal shivering. Method A prospective cohort study design was employed on 516 patients undergoing orthopedic surgery under spinal anesthesia, and they were selected by a consecutive sampling technique. Patients were divided into two groups based on the anesthetist in charge. Patients who received an intravenous prophylactic dose of Ketamine before spinal anesthesia are called Ketamine groups and patients who received Tramadol are called Tramadol groups (control). The severity and incidence of shivering, blood pressure, heart rate, and axillary body temperature were measured and recorded for one hour at 10-min intervals during the intraoperative period. Descriptive statistics, chi-square, independent t-test, and multivariable logistic regression were used. Significance was declared at a p-value lower than 0.05. Results The overall incidence of post-spinal shivering was 187 (36.2%), of which it was 74 (28.7%) on ketamine and 113 (43.8%) on tramadol with a p-value of 0.001. The incidence of nausea and vomiting was 157 (60.9%) on tramadol and 8 (3.1%) on ketamine, with a p-value of 0.001. Patients aged 18–35 years (AOR 0.08 (0.02, 0.27), 36–55 years (AOR 0.24, 0.07, 0.81), and those patients with a prolonged duration of surgery (AOR 1.47 (1.37–1.58)) were more likely to experience post-spinal shivering. And Low-dose ketamine has a protective effect against developing post-spinal shivering with an AOR of 0.427 (0.28–0.63). Conclusion Low-dose ketamine is more effective in reducing the incidence and severity of shivering after spinal anesthesia. Therefore, we recommend using low-dose ketamine to be effective as a prophylactic for post-spinal shivering in those patients undergoing orthopedic surgery under spinal anesthesia.

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Randomized controlled, double-blind study to evaluate oral clonidine to prevent post-subarachnoid block shivering in patients undergoing elective urological surgery

Cited by 10 publications

References 0 publications

Effects of oral premedication with tramadol, pregabalin or clonidine on shivering after spinal anaesthesia in patients undergoing hysteroscopic procedures

Effects of oral premedication with tramadol, pregabalin or clonidine on shivering after spinal anaesthesia in patients undergoing hysteroscopic procedures

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

The effect of ketamine versus tramadol on prophylactic post-spinal shivering in those patients undergoing orthopedic surgery: a prospective cohort study design, 2020

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