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CLINICAL INVESTIGATION
Year : 2012  |  Volume : 56  |  Issue : 4  |  Page : 370-375

Randomized double-blind comparison of prophylactic ketamine, clonidine and tramadol for the control of shivering under neuraxial anaesthesia


Department of Anesthesiology and Critical Care, Vardhman Mahavir Medical College and Safdarjung Hospital, Delhi, India

Correspondence Address:
Nikhil Jain
D-103, Narwana Apartment, I. P. Extension, Delhi - 92
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-5049.100821

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Background: Shivering is a common problem during neuraxial anaesthesia. Neuraxial anaesthesia impairs thermoregulatory control and up to a 56.7% incidence of shivering has been reported. Aim: To evaluate the effectiveness of prophylactic use of intravenous ketamine, clonidine and tramadol in control of shivering and to note any side-effects of the drugs used. Setting and Design: Randomised double-blind study. Methods: This study was conducted in 200 ASA grade I and II patients. Neuraxial block was performed with 2.8 mL (14 mg) of 0.5% bupivacaine heavy in all patients. The patients were randomly allocated into four groups of 50 each to receive saline as placebo (group P), ketamine 0.5 mg/kg (group K), Clonidine 75 mcg (group C) and Tramadol 0.5 mg/kg (group T). Temperature and hemodynamic parameters were recorded at every 5-min interval. Shivering was graded from 0 to 4 grades and, if grade 3 shivering occurred, the study drug was considered as ineffective and intravenous pethidine 25 mg was given as rescue drug. Statistical Analysis: Data among groups was compared using one-way ANOVA. The incidence of shivering and side-effects were compared using the chi-square test. Results: The incidence of grade 3 shivering showed a statistically significant difference (P=0.001) in group P (27/50) as compared with the other groups (group K=5/50, group C=2/50, group T=4/50). No drug showed any statistically significant advantage over the other. No major hemodynamic changes were seen with prophylactic use of test drugs; however, sedation score was significantly higher in group K (P<0.05) as compared with the other groups. Conclusion: The prophylactic use of ketamine, clonidine and tramadol were effective in preventing shivering during neuraxial anaesthesia without causing any major untoward side-effects.


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