Comparison of Intrathecal Nalbuphine and Magnesium Sulphate for Prevention of Shivering in Caesarean Section: A Randomised Clinical Study

Abstract

Introduction: Nalbuphine and magnesium sulfate are commonly used drugs for the treatment of Perioperative Shivering (POS), but there is a paucity of comparative studies on their intrathecal use in Lower Segment Caesarean Section (LSCS) patients. LSCS is the most commonly performed obstetric surgery, and Spinal Anaesthesia (SA) is advantageous in LSCS. However, shivering has been found to be the most common side-effect of SA. Aim: To compare the effect of intrathecal injection of nalbuphine and magnesium sulfate on the prevention of postspinal anaesthesia shivering during LSCS. Materials and Methods: This randomised clinical study was conducted at the Department of Anaesthesiology, Government Medical College, Kathua, Jammu and Kashmir, India on 60 parturients between the ages of 20-40 years from September 2021 to January 2023. The participants had full-term gestation and an American Society of Anaesthesiologists (ASA) status of I or II, and were scheduled for LSCS under SA. The total sample was divided into two groups of 30 patients each. Group N (n=30) received 0.7 mg nalbuphine intrathecally, while Group M (n=30) received 25 mg of magnesium sulfate intrathecally, both with 0.5% bupivacaine (10 mg). Characteristics of spinal blockade, time to onset of shivering, severity of shivering, and side-effects such as nausea, vomiting, sedation, and hypotension were noted. Student’s t-test, Chi-square test, and Fisher’s exact test were used for data analysis. A p-value of <0.05 was considered statistically significant. Results: Both study groups were comparable in terms of age (p-value=0.081), height, weight (p-value=0.079), ASA grade (p-value=0.072), and duration of surgery (p-value=0.077). In group N, 5 patients (16.67%) had POS, while in Group M, 6 patients (20%) had POS, but the difference was not statistically significant. In Group N, 3 patients (10%) had a shivering score of 3 and 2 patients (6.67%) had a shivering score of 4, while in group M, 3 patients (10%) had a shivering score of 3 and 3 patients (10%) had a shivering score of 4. The difference was statistically insignificant. Perioperative complications (sedation, hypotension, nausea, and vomiting) were comparable in both groups with no statistically significant difference. Conclusion: Intrathecal injection of preservative-free 0.7 mg nalbuphine and 25 mg magnesium sulfate were both effective in reducing the incidence of postspinal shivering. Both drugs had comparable minimum perioperative complications. The intrathecal use of nalbuphine and magnesium sulfate for the prevention of postspinal shivering is encouraged, as both drugs are less expensive and readily available in the operation theaters.