Shivering Control in Subarachnoid Block by Nalbuphine - A Comparative Study with Pethidine

Chowdhury, Shahnewaz; Ahmed, Sajjad; Haque, M Masudul; Hossain, Mozaffer

doi:10.3329/jbsa.v20i2.3994

Cited by 3 publications

(7 citation statements)

References 8 publications

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“…Our study results corroborate with study of Choudhury et al which had almost 100% response rate when they had used nalbuphine in the dose more than 0.08 mg/kg. [7] We have also observed that response rate of 73% and 98% when 0.06 mg/kg and 0.08 mg/kg of the study drug were used. The difference in the response rate from the previous studies where it was around 80% (6,8) may be attributed to the difference in the study population (pregnant patient in the former study and inclusion of all types of surgery in the other study).…”

Section: Discussionmentioning

confidence: 80%

“…[6] Another study by Wang et al concluded that both nalbuphine (0.08 mg/kg) and meperidine (0.4 mg/kg) provide a similar rapid and potent anti-shivering effect. [8] Choudhury et al in their study observed that 5 mg nalbuphine is qualitatively superior to 25 mg of meperidine for control of shivering [7] and also they had taken dose of nalbuphine of 0.086 mg/kg. So from the previous studies, it is observed that nalbuphine is effective in the dose range of 0.05 to 0.086 mg/kg.…”

Section: Discussionmentioning

confidence: 99%

“…Allowing for the probability of type II error of 0.1 and type I error of 0.05 (Considering the success rate of the N4 group of 70%, N6 group of 80%, N8 group 90% and N10 group 95% as per the results of previous studies) (7,8,9), it was estimated that 92 subjects per group would be required. To increase the power of the study and to counter exclusion of cases due to blood transfusion, the recruitment target was kept at 100 subjects per group or 400 overall.…”

Section: Discussionmentioning

confidence: 99%

“…While the mechanism of action for nalbuphine is still up for debate, studies have found this drug effective for the treatment of shivering. [6][7][8] Meperidine and tramadol are commonly used opioids for control of shivering by anaesthesiologists in modern days compared to nalbuphine. This is probably due to lack of evidence on the most effective dose for anti-shivering effect of nalbuphine.…”

Section: Discussionmentioning

confidence: 99%

“…[4] Previous studies had compared nalbuphine with meperidine and tramadol using three different doses of nalbuphine for control of post spinal shivering and observed that all the doses of nalbuphine to be equally efficacious. [6,7,8] But no study till date is available suggesting the optimum dose of nalbuphine to treat shivering. Hence, we planned a prospective, randomised, double blind study comparing the efficacy, haemodynamic changes and adverse effects of four different doses of nalbuphine (0.04, 0.06, 0.08 and 0.1 mg/kg) when used for controlling the post spinal shivering.…”

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confidence: 99%

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Comparison Between Different Doses of Nalbuphine for Management of Post Spinal Shivering - A Prospective, Randomised, Double Blind Study

Bhar¹,

Basunia²,

Das³

et al. 2016

jemds

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BACKGROUND Nalbuphine, a semisynthetic opioid agonist-antagonist, is effective in controlling of post spinal shivering. Till date several studies have compared the efficacy of nalbuphine using different doses but none have suggested the optimum dose for post spinal shivering.The aim of this study is to compare the efficacy and adverse effects of four doses of nalbuphine (0.04, 0.06, 0.08 and 0.1 mg/kg) and to quantify the optimum dose when used for management of post spinal shivering. MATERIALS AND METHODSIn a prospective double-blind randomised control trial, 400 American Society of Anaesthesiologists grade-l (ASA I) patients aged between 18 and 60 years, scheduled for various orthopaedic operations under spinal anaesthesia, who had developed shivering were selected. The patients were divided into four groups (N4, N6, N8 and N10) and treated with 0.04, 0.06, 0.08 and 0.1 mg/kg of nalbuphine respectively when shivering started. Response time (Time required for cessation of shivering), response rate (Measured from the effectiveness of the drug within 15 min. of administration), recurrence of shivering and adverse effects were noted. RESULTSResponse rate was significantly higher in N8 and N10 groups compared to other groups (p<0.05). Response time and recurrence were significantly lower in N8 and N10 groups (p<0.05). No significant difference was observed in N8 and N10 groups regarding efficacy. Two patients of N10 group developed transient respiratory depression. CONCLUSIONNalbuphine 0.08 mg/kg is the optimum dose for controlling of shivering with minimum side effects. Increasing the dose does not improve the efficacy but increases chances of complications.

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Section: Discussionmentioning

confidence: 80%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Comparison Between Different Doses of Nalbuphine for Management of Post Spinal Shivering - A Prospective, Randomised, Double Blind Study

Bhar¹,

Basunia²,

Das³

et al. 2016

jemds

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Comparison between the height of spinal block and the incidence of hypotension among surgical patients

Abdullahi

2024

Pyramid J Med

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Hypotension is one of the common complications of spinal anesthesia; caused by sympathetic blockade leading to reduced cardiac output. Hypotension may be associated with the height of spinal block and can reduce blood flow to organs thereby leading to cardiovascular collapse which may eventually lead to cardiac arrest if appropriate action is not taken. This study examines the relationship between the height of spinal block and development of hypotension. One hundred (100) ASA I and II patients whose surgeries were below the umbilicus and done under spinal anesthesia were enrolled for the study. Patients that had hypotension were recorded and the heights of block were also recorded. Eleven patients (11) had hypotension (11%) overall. The incidence of hypotension among groups T6, T8 and T10 were 25% (7), 18.75% (3)s and 2.04% (1) respectively with a p-value of 0.5 which was not statistically significant. This study has shown that the incidence of hypotension is directly proportional to the height of spinal block though it is not statistically significant at T6 and below.

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Efficacy of intravenous nalbuphine for managing post-anaesthesia shivering: A systematic review and meta-analysis of randomised controlled trials with trial sequential analysis

Nair,

Dudhedia,

Rangaiah

et al. 2023

Indian Journal of Anaesthesia

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Background and Aims: Post-anaesthesia shivering is distressing and is observed after spinal and general anaesthesia. Nalbuphine, a partial mu-opioid receptor antagonist with kappa-opioid receptor agonist properties, has been successfully used to manage post-anaesthesia shivering. Methods: After registering the review with the International Prospective Register of Systematic Reviews (PROSPERO), we searched PubMed/Medline, Scopus, Ovid, Cochrane Library and clinicaltrials.gov with keywords for randomised controlled trials. The risk of bias-2 (RoB-2) scale was used to assess the quality of evidence. We also used Grading of Recommendations, Assessment, Development and Evaluations (GRADE) guidelines to evaluate the strength of evidence and trial sequential analysis to validate the conclusions. Results: Of the 240 articles, 10 were considered eligible for review (700 patients, 350- nalbuphine, 350- control or placebo). When compared to placebo, the success rate of nalbuphine controlling shivering was significantly better (risk ratio [RR]: 2.37, 95% confidence interval [CI]:1.91, 2.94; P = 0.04, I² = 94%), but comparable to the control group drugs (opioids, dexmedetomidine, ondansetron, pethidine). Compared to placebo, shivering recurrence was significantly less with nalbuphine than with placebo (RR: 0.47, 95% CI: 0.26, 0.83; P = 0.01, I² = 61%), but comparable with the control group. The incidence of postoperative nausea/vomiting (PONV) was significantly less with nalbuphine when compared to the control group (RR: 0.67, 95% CI: 0.47, 0.95; P = 0.02, I² = 37%), but PONV in the nalbuphine group was comparable to placebo (RR: 1.20, 95% CI: 0.68, 2.12; P = 0.54, I² = 0%). Other outcomes, like the grade of shivering and hypotension, were comparable between the nalbuphine and control groups. Conclusion: Nalbuphine successfully controls post-anaesthesia shivering and reduces the recurrence of shivering.

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Shivering Control in Subarachnoid Block by Nalbuphine - A Comparative Study with Pethidine

Cited by 3 publications

References 8 publications

Comparison Between Different Doses of Nalbuphine for Management of Post Spinal Shivering - A Prospective, Randomised, Double Blind Study

Comparison Between Different Doses of Nalbuphine for Management of Post Spinal Shivering - A Prospective, Randomised, Double Blind Study

Comparison between the height of spinal block and the incidence of hypotension among surgical patients

Efficacy of intravenous nalbuphine for managing post-anaesthesia shivering: A systematic review and meta-analysis of randomised controlled trials with trial sequential analysis

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