Effect of Preemptive Clonidnine Versus Pethidine and Ketamine on Postoperative Shivering During Spinal Anesthesia

Abstract

Introduction: Postoperative Shivering is an early postoperative complication. Incidence of postoperative shivering (POS) following surgeries varies between 20 to 60%. There is still no consensus on treatment modalities especially in opioid-dependent patients. Aim: To compare the effect of preemptive clonidine, ketamin and pethidine in controlling postoperative shivering in addicted patients who undergo spinal anesthesia. Methods: In a clinical trial, 81 patients who underwent spinal anesthesia for elective orthopaedic surgery for lower limb were enrolled and assigned to groups of 27 patients of the study based on accidental numbers, and 2 patients in Pethidine group and 2 patients in ketamine group were excluded from the study. Clonidine 2 mg was administered orally prior to surgery. Ketamin 2mg/kg and pethidine 0.5 mg/kg were administered in recovery to the patients. Postoperative shivering was measured in patients during stay in post anethesia care unit. Blood pressure and heart rate was recorded during 30 minutes after spinal anethesia in operating room. Results: No significant differences in blood pressure and heart rate were observed between patients. Incidence of postoperative shivering was 28% in clonidine, 36% in pethidine and 48% in ketamin group. Risk of shivering was significantly reduced in patients received clonidine in compare to ketamine (RR: 0.34, 95% CI: 0.138-0.856, p=0.022) which was significant and compare to pethidine (RR=0.79, 95% CI: 0.272-2.323, p=0.67) which was not significant. Conclusion: preemptive Clonidine has superior effect compare to postoperative ketamin and pethidine in controlling postoperative shivering.