Comparative Evaluation of the Intravenous Dexmedetomidine and Nalbuphine for Treatment of Post Spinal Shivering-A Randomized Prospective Trial.

BACKGROUND Shivering is one of the most common complications of spinal anesthesia because of inhibition of the thermoregulatory control. Dexmedetomidine and nalbuphine are the two commonly used drugs for treatment of perioperative shivering, but owing to paucity of their comparative data, we planned this study to compare the efficacy of these two drugs for treatment of post spinal shivering. METHODS This study was conducted on 80 American Society of Anesthesiologists physical status I or II patients aged from 18 to 60 years who developed post-spinal shivering of grade III or IV during elective surgeries. These patients were randomly allocated into two groups (40 each). In group D, dexmedetomidine 0.50 μg/kg, and in group N, nalbuphine 0.08 mg/kg was given intravenously for treatment of shivering. Data regarding response time, recurrence rate and success rate along with their adverse effects were noted, and statistical analysis was performed using SPSS software version 17.0 (SPSS Inc., Chicago, IL, USA). RESULTS The mean response time was significantly shorter in group D as compared to Group N (1.9 ± 0.6 min and 4.7 ± 1.1 min, respectively; P ＜ 0.001), but the success rate in both groups was 100%. Recurrence of shivering was greater in group N as compared to group D, but this difference was statistically insignificant. Although hypotension and bradycardia were observed more in group D and nausea was observed more in group N, the difference among both the groups was statistically insignificant. CONCLUSIONS Dexmedetomidine is a better alternative than nalbuphine for treatment of post spinal shivering with quicker response time and comparable side effects.

[1]  P. Bhattacharya,et al.  Randomized Double-Blinded Comparative Study of Intravenous Nalbuphine and Tramadol for the Treatment of Postspinal Anesthesia Shivering , 2020, Anesthesia, essays and researches.

[2]  Jinguo Wang,et al.  Intravenous dexmedetomidine versus tramadol for treatment of shivering after spinal anesthesia: a meta-analysis of randomized controlled trials , 2020, BMC Anesthesiology.

[3]  S. Sun,et al.  Comparison of nalbuphine, ondansetron and placebo for the prevention of shivering after spinal anaesthesia for urgent caesarean delivery: a randomised double-blind controlled clinical trial. , 2019, International journal of obstetric anesthesia.

[4]  Gehui Li,et al.  Nalbuphine versus dexmedetomidine for treatment of combined spinal-epidural post-anesthetic shivering in pregnant women undergoing cesarean section , 2019, The Journal of international medical research.

[5]  W. Yao,et al.  The effects of novel α2-adrenoreceptor agonist dexmedetomidine on shivering in patients underwent caesarean section , 2019, Bioscience reports.

[6]  Sohair A. Megalla,et al.  Dexmedetomidine versus Nalbuphine for treatment of postspinal shivering in patients undergoing vaginal hysterectomy: A randomized, double blind, controlled study , 2017 .

[7]  S. Basunia,et al.  COMPARISON BETWEEN DIFFERENT DOSES OF NALBUPHINE FOR MANAGEMENT OF POST SPINAL SHIVERING - A PROSPECTIVE, RANDOMISED, DOUBLE BLIND STUDY , 2016 .

[8]  K. Fares,et al.  Safety and Efficacy of Dexmedetomidine in Treating Post Spinal Anesthesia Shivering: A Randomized Clinically Controlled Dose-Finding Trial. , 2016, Pain physician.

[9]  Z. Zou,et al.  Efficacy of dexmedetomidine on postoperative shivering: a meta-analysis of clinical trials , 2015, Canadian Journal of Anesthesia/Journal canadien d'anesthésie.

[10]  J. Vasanthy.  A Comparative Study of the Effect of Clonidine Tramadol and Nalbuphine on Postspinal Anaesthesia Shivering , 2015 .

[11]  Abby Morrow-Barnes.  Temperature monitoring. , 2014, Nursing standard (Royal College of Nursing (Great Britain) : 1987).

[12]  K. Gupta,et al.  Randomised double-blind comparative study of dexmedetomidine and tramadol for post-spinal anaesthesia shivering , 2014, Indian journal of anaesthesia.

[13]  G. Jain,et al.  Control of shivering with clonidine, butorphanol, and tramadol under spinal anesthesia: a comparative study , 2011, Local and regional anesthesia.

[14]  K. Malhotra,et al.  A comparative study of the effect of clonidine and tramadol on post-spinal anaesthesia shivering , 2011, Indian journal of anaesthesia.

[15]  D. Buggy,et al.  Shivering and Neuraxial Anesthesia , 2007, Regional Anesthesia & Pain Medicine.

[16]  P. Kranke,et al.  Pharmacological Treatment of Postoperative Shivering: A Quantitative Systematic Review of Randomized Controlled Trials , 2002, Anesthesia and analgesia.

[17]  D. Sessler,et al.  Perioperative Shivering: Physiology and Pharmacology , 2002, Anesthesiology.

[18]  R. Lodha,et al.  Is axillary temperature an appropriate surrogate for core temperature? , 2000, Indian journal of pediatrics.

[19]  P. Talke,et al.  Dexmedetomidine Does Not Alter the Sweating Threshold, But Comparably and Linearly Decreases the Vasoconstriction and Shivering Thresholds , 1997, Anesthesiology.

[20]  A. Bjorksten,et al.  The Effect of Opioids on Thermoregulatory Responses in Humans and the Special Antishivering Action of Meperidine , 1997, Annals of the New York Academy of Sciences.

[21]  I. Wrench,et al.  The minimum effective doses of pethidine and doxapram in the treatment of post‐anaesthetic shivering , 1997, Anaesthesia.

[22]  K. Filos,et al.  Hemodynamic and Analgesic Profile after Intrathecal Clonidine in Humans: A Dose-Response Study , 1994, Anesthesiology.

[23]  Dhiraj Bhandari,et al.  Comparative Evaluation of Dexmedetomidine and Tramadol for Attenuation of Post-Spinal Anaesthesia Shivering , 2018 .

[24]  Manohar Panneer,et al.  A Comparative Study of Intravenous Dexmedetomidine and Intravenous Clonidine for Postspinal Shivering in Patients Undergoing Lower Limb Orthopedic Surgeries , 2017, Anesthesia, essays and researches.