CONTROL OF SHIVERING UNDER SPINALANAESTHESIA- A PROSPECTIVE RANDOMIZED COMPARATIVE ANALYSIS OF BUTORPHANOL, TRAMADOL AND CLONIDINE

Abstract

INTRODUCTION: Shivering that develops following spinal anaesthesia is a common problem and may occur in 40- 70% of patients .Perioperative hypothermia is the primary cause which occurs due to inhibition of thermoregulatory mechanism in the hypothalamus. It is detrimental to the patient hence effective control of shivering is mandatory. AIM: To compare the relative efcacy of Butorphanol, Tramadol and Clonidine and nd rst line of management for the control of shivering during spinal anaesthesia in lower abdominal,lower limb and open gynaecological surgeries and study their side effects MATERIALS AND METHOD:114 (38 for each drug group) ASA 1 and 2 patients of either gender, aged between 18 to 65 yrs in the above mentioned surgeries who developed shivering after spinal anaesthesia were included in the study. Tab. Diazepam 10 mg was given the night before and morning of surgery. Baseline heart rate, SpO , Blood pressure, ECG and axillary temperature were recorded. Subarachnoid block was performed with Inj. Bupivacaine 2 heavy 0.5% (3-4 ml) at L3-L4/L4-L5 interspace.Heart rate, SpO , NIBPand axillary temperature was recorded till 1 hour post operatively. For the 2 patients who developed grade 2 and above of shivering , group B received 1mg Butorphanol ,group T 1mg /kg Tramadol and group C 1 µg/kg Clonidine randomly after diluting to 5 ml.The time and temperature at onset of shivering,time taken for control of shivering ,side effects- nausea, vomiting, hypotension, bradycardia,dry mouth,skin rash,sedation score,recurrence of shivering were noted.Statistical analysis was done using One way Anova and Chi square tests .RESULTS: There was a statistically signicant difference in between the drug groups only for recurrence of shivering after drug. More recurrence was found with Clonidine. There was signicant reduction in heart rate at 1 hour in Clonidine group compared to B and T groups. ASA-ps, grade of shivering, duration, time at onset of shivering, pre-op temp, temp at onset, time to control of shivering, SBP, DBP, MAP and SpO2 differences were not statistically signicant.CONCLUSION: Clonidine caused more recurrence and more reduction in heart rate. Butorphanol had a faster control of post spinal shivering though not statistically signicant. Tramadol and Butorphanol can be used with almost no side effects for post spinal anesthesia shivering,a higher dose of Clonidine may be required.