Postanesthetic Shivering Research Articles

RELATIONSHIP OF LONG OPERATION WITH SHIVERING EVENTS IN POST SPINAL ANESTHETIC PATIENT AT RSUD LEUWILIANG BOGOR REGENCY

Shivering is a complication of spinal anesthesia with an incidence of up to 33-57%. The long duration of surgery causes the anesthetic procedure to be longer. This will increase the time of exposure of the body to cold temperatures and cause the effect of accumulating drugs and anesthetic agents. Data on surgical patients at Leuwiliang Regional Hospital from December 2021 to February 2021, namely 60% of patients underwent surgery <1 hour, 20% underwent 1-2 hours of surgery, and 20% underwent >2 hours of surgery. The incidence of shivering at Leuwiliang Regional Hospital is 5 out of 10 patients (50%). The study aimed to determine the relationship between the duration of surgery and the incidence of shivering in patients after spinal anesthesia at Leuwiliang Hospital, Bogor Regency. The research method uses a type of analytics that is cross-sectional. The population in this study was 1212 respondents. The sampling technique in this study used purposive sampling techniques for 92 respondents.The data was taken by making observations to respondents. The results showed that the duration of the operation was 1-2 hours as many as 51 respondents (55.4%). The incidence of shivering in patients after spinal anesthesia found that there was a degree 3 shivering of 54 respondents (58.7%). There is a long association of surgery with the incidence of shivering in post-spinal anesthesia patients with a p-value of 0.001 (P<0.05). To Leuwiliang Hospital, especially for anesthesiologists, to increase vigilance against post-anesthesia shivering events to prevent complications after spinal anesthesia

A systematic review on considering the role of Magnesium in preventing post-anesthesia shivering.

Shivering following anesthesia is caused by disturbed regulation of body temperature and causes an increase in tissue oxygen consumption and cardio-pulmonary activity. Choosing the right medicine to reduce shivering with the most negligible side effects in surgery is essential. Magnesium is prescribed intravenously, epidurally, or intra-peritoneally. Each of these methods can have different effects in different surgical operations. In this review, we are looking for randomized clinical trials that compared preoperative magnesium administration with a control group and included studies that evaluated the degree of shivering as a primary outcome variable. This study aimed to evaluate pre-operative magnesium's effect in preventing shivering after surgery. This article was a systematic review type, in which all quality articles published until the end of 2021 were searched with the keywords magnesium, shivering, surgery, and prevention via different databases, including PubMed, Cochrane Central Register of Tested Controlled, EMBASE and Web of Science. In the initial search, 3294 publications were identified. 64 articles were included in this study. The results indicated that shivering in the magnesium group with IV epidural injection inside the peritoneum was significantly reduced compared to the control group. It was also identified in the examination of symptoms. Variants such as extubation time, length of stay in PACU, magnesium serum concentration, spinal c-fos mRNA expression, nausea or vomiting, sedation, itching, pressure drop, and bradycardia were significantly less reported than the control group. In general, the results showed that the preventive use of magnesium could decrease the intensity and number of post-anesthesia shivering and other post-anesthesia symptoms.

Examination of Three Distinct Dosages of Dexmedetomidine for Counteraction of Postspinal Sedation Shivering in Transurethral Resection of Prostate (TURP) Medical Procedure

Background: The ideal portion of dexmedetomidine for shivering control with the most un-hemodynamic disturbances is still under research. Postanesthetic shivering (PAS) is an unsavory and possibly serious difficulty. Not very many investigations have been finished in regards to the ideal compelling portion of dexmedetomidine for the counteraction of postspinal anesthesia (SA) shivering. Accordingly, we expected to look at and assess three distinct portions of intravenous dexmedetomidine and to explore the ideal portion of dexmedetomidine that successfully forestalls shivering in patients going through transurethral resection of the prostate (TURP). Materials and Methods: In this randomized, twofold visually impaired, planned study, 135 patients of the American Society of Anesthesiologists I and II booked for elective TURP under SA were selected. Patients were haphazardly apportioned into one of the three gatherings getting dexmedetomidine: Group P: 0.5 μg/kg, Group Q: 0.75 μg/kg, and Group R: 1.0 μg/kg. The essential result of the review was intraoperative rate of shivering. The optional results, like hemodynamic boundaries. Results: Shivering score of various gatherings uncovered measurably huge lower occurrence and seriousness of shivering in Group Q and Group R when contrasted with Group P(P = 0.0395). Occurrences of sickne, bradycardia, and hypotension were more in Group R when contrasted with Group P and Group Q. Axillary temperature and sedation scores were equivalent among various gatherings (P > 0.05). Conclusion: Dexmedetomidine in the dose of 0.75 μg/kg furnishes sufficient antishivering impact with added advantage of sedation and less hemodynamic disturbance.

A meta-analysis of randomized controlled trials: efficiency and safety of ondansetron in preventing post-anesthesia shivering during cesarean section.

Although ondansetron was considered to prevent post-anesthesia shivering during cesarean section, its efficiency remained controversial. Our review was conducted to estimate the efficiency and safety of ondansetron in preventing post-anesthesia shivering during cesarean section. The literature were searched from their inception to October 2020 without restriction of language. All randomized controlled trials investigating the efficacy of ondansetron versus placebo in preventing shivering during cesarean section under neuraxial anesthesia were included. The meta-analysis was conducted using Stata software. Eleven randomized controlled studies with a total of 748 individuals were finally included in our meta-analysis. Our results manifested that intravenous ondansetron compared with intravenous placebo significantly reduced the incidence of post-anesthesia shivering (PAS) (RR 0.53, 95% CI 0.14-0.68). Subgroup analysis according todoses of ondansetron indicated that the efficacy of 4mg doses of ondansetron (RR 0.37, 95% CI 0.21-0.64)is equivalent to that of 8mg doses of ondansetron (RR 0.61, 95% CI 0.47-0.81) in preventing PAS. In addition, the intravenous ondansetron led to a lower incidence of hypotension than intravenous placebo (OR 0.47, 95% CI 0.32-0.70). We could not demonstrate differences in the incidence of bradycardia between intravenous ondansetron and intravenous placebo. Our results found that intravenous ondansetron was effective in preventing shivering during cesarean section under neuraxial anesthesia, and had an advantage in reducing the incidence of hypotension compared with intravenous placebo.

Comparison of dexmedetomidine and meperidine for the prevention of shivering following coronary artery bypass graft: study protocol of a randomised controlled trial

IntroductionShivering is a common complication in the postoperative period. The incidence of shivering has been reported to range from 5% to 65% under general anaesthesia and as 33% during epidural...

Hyperbaric Bupivacaine alone Versus Hyperbaric Bupivacaine and Tramadol Combination for Shivering in Spinal Anaesthesia Surgeries

Background: Shivering is a normal physiologic protective mechanism of the body, which in response to core hypothermia, increases metabolic heat production that results in involuntary, oscillatory muscle activity. Spinal anesthesia promotes redistribution of body heat from central to the peripheral compartments. After spinal anesthesia shivering occurs in 40-60% of patients. Tramadol is synthetic codeine analog that is weak Mu opioid receptor agonist. It also has effect of norepinephrine and serotonin reuptake inhibition. It proves to be more effective in prevention and treatment of shivering and it also has less side effects then Mu opioid agonists. Objective: To compare the outcome of hyperbaric bupivacaine alone, with combination of hyperbaric bupivacaine and tramadol to prevent frequency of shivering in spinal anaesthesia. Study Design: Randomized clinical trial study. Place and Duration of Study: Department of Anaesthesiology & Gynaecology, POF Hospital, Wah Cantt, HIT Taxilla and Izzat Ali Shah Hospital, Wah Cantt from 1st December 2018 to 31st December 2020. Methodology: One hundred and 100 patients were included and divided into two equal groups. Patients in Group A received 2ml of 0.75% hyperbaric bupivacaine (15mg) and group B received 2ml of 0.75% hyperbaric bupivacaine (15mg) and preservative free tramadol (10mg, 0.2ml) in spinal anesthesia. Results: There were 13 (26%) female patients in group A and 37 (74%) male patients. In group B there were 35 (70%) male patients and 15 (30%) female patients. The mean age in group A was 42±8.05 years and 42±8.02 years in group B. Thirty two (64%) in whom shivering was present and 18 (36%) no shivering accrued in group A while in group B, 11 (22%) in whom shivering was present and 39 (78%) no shivering accrued (P<0.05). Conclusion: Post-anesthetic shivering appeared to be present in post spinal anaesthesia patients very commonly. Administration of tramadol has proved to significantly reduce incidence of shivering. More studies still need to be done on tramadol to confirm its efficacy in preveting and stopping shivering without systemic effects on patients. Keywords: Spinal anaesthesia, Bupivacaine, Tramadol, Shivering

Dexmedetomidine versus tramadol for preventing postanesthesia shivering following major maxillofacial surgery

Background and aims Shivering is distressing to the patient and discomforting to the attending anesthesiologist, with a varying degree of success. Various drugs and regimens have been used to abolish the occurrence of shivering. This study aims to study and compare the efficacy of dexmedetomidine and tramadol in the prevention of post general anesthesia shivering in patients undergoing major maxillofacial surgery.Patients and methods The study was carried out on 64 adult patients, in the age group from 20 to 60 years of both sexes, American Society of Anesthesiology physical status I and II, admitted at the Maxillofacial Surgery Department at Alexandria Main University Hospital and scheduled for major maxillofacial surgery lasting for more than 4 h. Patients were randomly divided into two equal groups of 32 patients each, using sealed envelopes. This study was a single-blinded study. Group I patients received intravenous dexmedetomidine 1.0 μg/kg 15 min before wound closure. Group II patients received intravenous tramadol 0.1 mg/kg 15 min before wound closure. Vital signs such as heart rate, blood pressure, oxygen saturation, core body temperature, and surface body temperature were observed and recorded on arrival to the postanesthesia care unit, 5, 10, 15, 20, 30 min, 1, 3, 6 h after surgery. Any incidence, occurrence, and duration of shivering was recorded and intensity of shivering using the four-point scale. Statistical analysis of the data were fed to the computer and analyzed using IBM SPSS software package, version 20.0. Qualitative data were described using number and percent. Quantitative data were described using range (minimum and maximum), mean, SD, and median. Significance of the obtained results was judged at the 5% level.Results There was no statistically significant difference between the two groups regarding demographic data, duration of anesthesia and oxygen saturation. Heart rate was statistically significantly lower in group I (dexmedetomidine) than in group II (tramadol group) (P≤0.001). There was a statistically significant difference in blood pressure between the two groups being lower in group I (dexmedetomidine). Core and surface body temperature were statistically significantly lower in group I (dexmedetomidine); there was no significant difference in either occurrence, intensity, or duration of shivering.Conclusions intravenous dexmedetomidine and tramadol seems to possess antishivering properties and were found to reduce the occurrence of shivering in patients undergoing general anesthesia.

THE DIFFERENCES IN THE EFFECTIVENESS OF PROVIDING THICK BLANKETS AND ELECTRIC BLANKETS WITH REDUCING SHIVERING INCIDENCE ON POSTOPERATIVE PATIENTS IN SURGICAL INSTALLATIONS DR. SITANALA HOSPITAL TANGERANG, INDONESIA IN 2019

Introduction: Post Anesthetic Shivering (PAS) or the incidence of post-anesthetic shivering is reported to be around 33-65% in patients undergoing general anesthesia and about 33-56,7% in patients undergoing spinal anesthesia. The treatment can be done pharmacologically with drugs and non-pharmacologically one of them with a warm blanket. The purpose of this study was to determine the differences in the effectiveness of giving thick cloth blankets and 380C electric blankets with a reduction in the incidence of shivering in postoperative patients at the Surgical Installation dr. SitanalaTangerang Hospital. Methods: The research method was a quantitative study with a quasi-experimental design with a pre-test post-test with control group design. The number of samples were 30 patients. Data was collected by observing shivering responses. The intervention was carried out by firing 380C electric blankets and thick cloth blankets. Result: The results showed that of the 15 postoperative patients before being given an electric blanket, almost half were 7 (46,7%) having grade 3 shivering, where as in patients given thick cloth blankets almost half were 6 (40%) having grade 2 shivering. Electrical heating is almost half that is 6 (40%) does not experience shivering (grade 0), where as in patients given regular blankets almost half are 6 (40%) experiencing grade 2 shivering. Statistical test results were obtained (p-value = 0.001, ? : 0.05) and (p-value = 0.005, ?: 0.05). Conclusion: there was an electric warm blanket or thick cloth blanket that influences the incidence of shivering in postoperative patients at the Surgical Installation dr. Sitanala Tangerang Hospital, but electric blankets are more effective than thick blankets. Suggestion is that the hospital is expected to make an intervention to provide electric warm blankets with a temperature of 380C postoperatively can be used as a fixed procedure for the service of surgical patients to prevent complications of shivering

Low-dose Intravenous Dexmedetomidine Reduces Shivering Following Cesarean Delivery: A Randomized Controlled Trial

(Int J Obstet Anesth. 2021;45:49–55) In cesarean deliveries (CD) shivering is sometimes brought on by neuraxial anesthesia. Shivering can negatively affect patient comfort and intraoperative monitoring of blood pressure, electrocardiogram and pulse. Meperidine is a synthetic opioid that has been used to treat postanesthetic shivering, but there are concerns about its side effects in pregnant women. Dexmedetomidine at a dose of 30 μg has been found to control shivering after CD, but with some unpleasant side effects like dry mouth. This study aimed to determine whether anesthetic shivering after CD would be reduced using a 10 μg dose of dexmedetomidine administered immediately after delivery.

CONTROL OF INTRAOPERATIVE SHIVERING UNDER SPINAL ANAESTHESIA- A PROSPECTIVE RANDOMIZED COMPARATIVE STUDY OF NALBUPHINE WITH TRAMADOL

spinal anesthesia is a widely used technique for both elective and emergency surgeries. Shivering is one of the most commonly recognized complications of the central neuraxial blockade because of impairment of thermoregulatory control, reported in 40%-70% of the patients undergoing surgery under spinal anaesthesia. Post-anesthetic shivering is defined as an involuntary,spontaneous,rhythmic oscillating muscle hyperactivity that increases metabolic heat production up to 600% after anesthesia. Shivering during neuraxial anesthesia is a common issue that could have possibly adverse impacts, for example, increased oxygen consumption, carbon dioxide production, lung ventilation and cardiac work, as well as causing diminished mixed venous oxygen saturation. Spinal anesthesia impedes the thermoregulatory system by restraining tonic vasoconstriction which assumes significant role in the regulation of temperature

Comparison of Intravenous Ketamine with Intrathecal Meperidine in Prevention of Post-anesthetic Shivering after Spinal Anesthesia for Lower Limb Orthopedic Surgeries: A Double-blind Randomized Clinical Trial.

Post-anesthetic shivering is one of the most common complications after anesthesia. Ketamine has been considered to be an effective treatment for post-anesthetic shivering, but the evidence for its therapeutic benefit after spinal anesthesia is limited. The aim of this study was to compare the effects of intravenous ketamine with intrathecal meperidine in the prevention of post-anesthetic shivering after spinal anesthesia for lower limb orthopedic surgeries. In a double-blind randomized parallel-group clinical trial, a total of 150 patients scheduled for lower limb orthopedic surgeries under spinal anesthesia were selected and randomly divided into three equally sized groups of intravenous ketamine (0.5 mg/kg), intrathecal meperidine (0.2mg/kg) or intravenous normal saline (as placebo). The intensity of shivering in patients were evaluated during surgery and after transfer into the post anesthesia care unit. Also, changes in patients' drowsiness, nausea, vomiting, pruritus, mean arterial pressure, heart rate, and arterial oxygen saturation (SPO2) during surgery and until the end of anesthesia were evaluated. In all times of evaluation (20, 60, 80, 100 and 120 minutes after onset of spinal anesthesia) patients in control group showed a greater intensity of shivering compared to other groups. However, patients who received intrathecal meperidine experienced significantly lower intensity of post anesthetic shivering (p<0.05). The results showed a significant mean arterial pressure and heart rates differences between the three groups, only on 20 and 60 minutes after initiation of spinal anesthesia. The incidence of nausea, vomiting, and pruritus was not significantly different in all three groups, although all patients who received ketamine experienced drowsiness after surgery (p<0.001). The results of the present study showed that, although both intrathecal meperidine and intravenous ketamine could effectively prevent postoperative shivering after spinal anesthesia in lower limb orthopedic surgeries, intrathecal meperidine was associated with more efficacy benefits and a lower frequency of side effects such as post-anesthesia drowsiness.

Effectiveness of Tramadol in Controlling Postanesthetic Shivering

Objectives: The objective of the study was to assess the effectiveness of intravenous tramadol in controlling post anesthetic shivering and to assess which of the dose of drug is safe and effective. Material and Methods: In this study we included 120 patients age &gt;18 years of ASA class I &amp; II who underwent any surgical procedure under spinal/general anesthesia. Patients were divided into 3 groups of equal size of 40 subjects. Group A; in these patients tramadol 0.25 mg/kg I/V was given for shivering management. Group B; in these patients Tramadol 0.5 mg/kg I/V was given and Group C (control group); in these patients normal saline 0.05 ml/kg I/V was given. The adequate control of shivering was the main study objective. Side effects of tramadol at different doses were also observed. Results: At five minutes, Grade 0,1 and 2 shivering were observed in 23 patients in group A and 31 patients in group B while in group C grade 3 and 4 shivering were observed. High grade (3 and 4) shivering were significantly high in group C than group A and B (p-value= 0.005). Similarly, at 10 minutes, grade 3 and 4 shivering were significantly high in group C than group A and B (p-value 0.005). Conclusion: IV 0.25 mg/Kg is an effective option for control of post-anesthesia shivering with minimal side effect profile. So low dose tramadol can be used as a first option for post-anesthesia shivering control. Keywords: Anesthesia, Shivering, Tramadol.

Addition of low dose ketamine to tramadol for prevention of post–anesthetic shivering: a comparative study

Addition of low dose ketamine to tramadol for prevention of post–anesthetic shivering: a comparative study

Prophylaxis of Post Spinal Shivering: A Comparative Study between Intravenous Ondansetron and Meperidine

Background: Shiveringis a common complication following anesthesia. Many drugs have been documented as a prophylaxis of postanesthesia shivering. The aim of this study was to find out a better drug as an antishivering agent.&#x0D; Materials and methods: This comparative study was carried out in the Department of Anesthesiology in Chittagong Medical College Hospital over a period of 6 months starting from November 2015 to April 2016. A total 90 obstetric patients with American Society of Anesthesiology (ASA) physical status I &amp; II underwent cesarean section received placebo (Group-C, n-30), Inj-Ondansetron 8mg (Group-O, n-30) and Inj-Meperidine 0.4mg/kg (Group-M, n-30). These drugs were administered during intraoperative period just after cord clamp. Incidence of shivering, hemodynamic parameters were observed immediate after spinal anesthesia &amp; then 5 min interval for 30 min throughout the intraoperative period.&#x0D; Results: Shivering was observed in 16 patients (53.33%) of group-C, 4 patients (13.33%) of group O and 8 patients (26.66%) of group M. The number of patient with a shivering grade 3 &amp; 4 were very highly significant (p&lt;0.001) in group C compared with other groups at 15 min &amp; 20 min after block &amp; significant (p&lt;0.05) at 25 min &amp; 30 min after block.&#x0D; Conclusion: Ondansetron was found to be more effective and haemodynamically stable drug than Meperidine in prophylaxis of post spinal shivering.&#x0D; JCMCTA 2021 ; 32 (1) : 53-58

Cross-sectional Study on Effects of Ondansetron and Meperidine in the Prevention of Postoperative Shivering after Spinal Anesthesia

Purpose: Post-anesthesia shivering is one of the most common problems after surgery and may lead to multiple complications such as hypoxemia, lactate acidosis and catecholamine release. The purpose of this study was to compare the effects of intravenous meperidine and ondansetron on postoperative shivering in patients having an elective cesarean section under spinal anesthesia. Design: Cross-sectional study Methods: In this cross-sectional study, 105 patients with the age of 18-45 years and ASA class I-II undergoing elective cesarean section were randomly assigned into three groups. Group O was administered 8mg ondansetron, group M patients were given 0.4mg/kg meperidine and group P was placebo that was administered with 2cc of saline intravenously after the delivery. The incidence and intensity of shivering and postoperative nausea was monitored and recorded by the trained nurse. The data obtained was analyzed using SPSS v18. Results: All three groups (n=35) had no significant difference in terms of age, weight and time of spinal anesthesia. Postoperative shivering was reported in 4 patients (11.4%) in group A and 3 patients (8.6%) in group B and in 14 patients (40%) in group C. The incidence of postoperative shivering was significantly less in groups A and B as compared to the placebo, p=0.03. The intensity of shivering was greater in group C as compared to groups A and B, p=0.01. The incidence and intensity of postoperative nausea was significantly less in group A, p=0.03, p&lt;0.001, respectively, while no difference was reported in groups B and C, p&lt;0.05. Conclusion: 8mg ondansetron and 0.4 mg/kg of meperidine are equally effective in managing postoperative shivering; however, ondansetron has an additional effect of reducing the incidence of postoperative nausea among patients undergoing caesarean section with spinal anesthesia.

Preoperative perfusion index as a predictor of post-anaesthetic shivering in caesarean section with spinal anaesthesia.

Post-anaesthetic shivering is frequently preceded by a decrease in peripheral blood flow. Perfusion index is a fast non-invasive method to assess peripheral blood flow, thus might be correlated with post-anaesthetic shivering. To analyse the relationship between preoperative perfusion index and post-anaesthetic shivering in patients undergoing caesarean section with spinal anaesthesia. In this prospective observational study, preoperative perfusion index measurements were performed on 40 participants who were undergoing elective caesarean section under spinal anaesthesia. Spinal anaesthesia was performed using Lidodex (Lignocaine + Dextrose 5%) at vertebrae L4-L5 or L3-L4 interspace. Shivering was observed until 120 minutes according to the Crossley and Mahajan scale. Statistical analysis was performed to examine the correlation and cut-off of preoperative perfusion index as a predictor for post-anaesthetic shivering. There was a significant relationship between preoperative perfusion index with the incidence (p = 0.005) and the degree (p = 0.014) of post-anaesthetic shivering. The preoperative perfusion index cut-off value based on the ROC curve was 4.2 (AUC = 0.762, p = 0.002) with a sensitivity of 73.9% and specificity of 88.2%. Participants with preoperative PI < 4.2 had a greater risk of post-anaesthetic shivering (p < 0.001, RR = 3.13). Preoperative perfusion index less than 4.2 can predict post-anaesthetic shivering in patients undergoing caesarean section with spinal anaesthesia.

The Efficacy of Prophylactic Intravenous Granisetron in Preventing Post Anaesthesia Shivering in Gynaecological Patients Undergoing Surgery Under General Anaesthesia

Post-anaesthetic shivering is one of the commonest complications during emergence from general anaesthesia with the rate of occurrence between 5 to 65%. It increases oxygen consumption and carbon dioxide production resulting in delayed recovery from anaesthesia and other adverse events. Granisetron is one of the drugs used to prevent post-anaesthetic shivering. This prospective, double-blind and randomised control study compared the efficacy of prophylaxis IV granisetron at 2 mg and 3 mg doses in preventing post-anaesthetic shivering. There were 104 patients, ASA I and II scheduled for elective open gynaecological surgery recruited and randomised into 2 groups: Group A and B, receiving 2 and 3 mg of IV granisetron, resepectively. Intravenous anaesthetic drugs were administered and tracheal intubation was facilitated by muscle paralysis. Patients’ baseline and periodic tympanic core temperatures were measured perioperatively. The incidence and severity of shivering were assessed postoperatively using Wrench Scoring Classification whereby Group A and B had 8.3% and 16.7% of incidence, respectively, in which they were not statistically significant (p = 0.199). All patients from both groups who shivered experienced Grade 1 shivering except for one patient who registered a Grade 2 in Group B. None of our patients had Grade 3 or 4 shivering postoperatively. No one experienced nausea or vomiting in the recovery area. Prophylactic IV granisetron of 2 mg and 3 mg were equally effective in reducing the incidence and severity of post-anaesthetic shivering in gynaecological patients undergoing surgery under general anaesthesia with no unpleasant side effects.

Efficacy of ondansetron and palonosetron in prevention of shivering under spinal anesthesia: A prospective randomized double-blind study in patients undergoing elective LSCS.

Background and Aims:Postanesthesia shivering (PAS) is a common, distressing experience. Ondansetron, the classical 5HT3 antagonist has been in use for its prevention since long. Palonosetron, a newly introduced potent antiemetic drug with better pharmacodynamics is currently in use by clinicians. Hence, a study was conducted to compare the efficacy of ondansetron and palonosetron in preventing PAS in patients undergoing elective lower segment caesarean section (LSCS) under spinal anaesthesia.Material and Methods:A total of 84 patients scheduled for elective LSCS under spinal anesthesia were randomly allocated to one of the two study groups (Group O & P). Accordingly, 8 mg of ondansetron or 0.075 mg palonosetron was administered in the same volume intravenously 30 min preoperatively. Sublingual temperature was recorded regularly. All patients were observed for 90 min postspinal for PAS. Observations were analyzed statiscally.Results:No statistically significant intergroup difference was observed in the duration of surgery, and sublingual temperature. However, statistically significant difference was recorded for PAS (23.8% in ondansetron group, 9.5% in palonosetron group).Conclusion:Prophylactic administration of palonosetron significantly reduced incidence of PAS compared to ondansetron. However, further studies with larger sample size and more heterogeneous groups are suggested.

A Randomised Clinical Trial to Compare the Efficacy of Tramadol and Nalbuphine for Treatment of Shivering after Spinal Anaesthesia in Patients Posted for Lower Limb Orthopaedic Surgery

Introduction: Nalbuphine and tramadol are opioids which have been used to control post-anaesthetic shivering. Aim: To compare the efficacy of nalbuphine and tramadol in the treatment of post-spinal anaesthesia shivering. Materials and Methods: This was a randomised clinical trial conducted on 60 patients of either gender (20-60 years age group) from January 2019 to June 2020, American Society of Anaesthesiologists (ASA) Grade I or II, having post-spinal anaesthesia shivering. The total sample was divided into two groups of 30 patients each. Group T received injection (Inj) tramadol 1 mg/kg intravenously (iv) and Group N received Inj. nalbuphine 0.1 mg/kg iv. Grade of shivering was assessed with a five point scale as Grade 0- no shivering; Grade 1; No visible muscle activity, but one or more of piloerection, peripheral vasoconstriction or peripheral cyanosis Grade 2; Muscular activity in only one muscle group; Grade 3: Moderate muscular activity in more than one muscle group, but not generalised shaking; Grade 4: Violent muscular activity that involves the entire body. The time taken for disappearance of shivering, assessment of improvement of shivering (complete- if grade of shivering becomes 0, partial- if grade of shivering deceased but not zero), recurrence rate and side-effects such as nausea, vomiting, deep sedation were noted. Independent t-test and Chi-square test were used to analyse the data. A p-value &lt;0.05 were considered statistically significant. Results: The time taken for disappearance of shivering was shorter in group N than T (3.20±0.96 minutes and 6.43±0.97 minutes respectively, p=0.001). Significantly better sedation (p-value 0.04) was seen in nalbuphine group as grade 3 sedation were seen in 15 patients of nalbuphine group as compared to none in tramadol group. All the patients in group N had complete improvement of shivering and there was no recurrence, while in group T six patients had partial improvement in shivering and four (13%) had recurrence. Complications such as nausea (three patients) and vomiting (one patient) were seen in Group T while none were seen in Group N. Conclusion: The efficacy of nalbuphine is greater than tramadol in controlling post-spinal anaesthesia shivering, with minimal side-effects.

Efficacy of flurbiprofen axetil for preventing postanesthetic shivering in patients undergoing gynecologic laparotomy surgeries

BackgroundPostanesthetic shivering is an unpleasant adverse event in surgical patients. A nonsteroidal anti-inflammatory drug has been reported to be useful in preventing postanesthetic shivering in several previous studies. The aim of this study was to evaluate the efficacy of flurbiprofen axetil being a prodrug of a nonsteroidal anti-inflammatory drug for preventing postanesthetic shivering in patients undergoing gynecologic laparotomy surgeries.MethodThis study is a retrospective observational study. I collected data from patients undergoing gynecologic laparotomy surgeries performed between October 1, 2019, and September 30, 2020, at Kumamoto City Hospital. All the patients were managed with general anesthesia with or without epidural analgesia. The administration of intravenous 50 mg flurbiprofen axetil for postoperative pain control at the end of the surgery was left to the individual anesthesiologist. The patients were divided into two groups: those who had received intravenous flurbiprofen axetil (flurbiprofen group) and those who had not received intravenous flurbiprofen axetil (non-flurbiprofen group), and I compared the frequency of postanesthetic shivering between the two groups. Additionally, the factors presumably associated with postanesthetic shivering were collected from the medical charts. Intergroup differences were assessed with the χ2 test with Yates’ correlation for continuity category variables. The Student’s t test was used to test for differences in continuous variables. Furthermore, a multivariate logistic regression analysis was performed to elucidate the relationship between the administration of flurbiprofen axetil and the incidence of PAS.ResultsI retrospectively examined the cases of 141 patients aged 49 ± 13 (range 21-84) years old. The overall postanesthetic shivering rate was 21.3% (30 of the 141 patients). The frequency of postanesthetic shivering in the flurbiprofen group (n = 31) was 6.5%, which was significantly lower than that in the non-flurbiprofen group (n = 110), 25.5% (p value = 0.022). A multivariate logistic regression analysis showed that administration of flurbiprofen axetil was independently associated with a reduced incidence of postanesthetic shivering (odds ratio 0.12; 95% confidence interval, 0.02-0.66, p value = 0.015).ConclusionsMy result suggests that intraoperative 50 mg flurbiprofen axetil administration for postoperative pain control is useful to prevent postanesthetic shivering in patients undergoing gynecologic laparotomy surgeries.