Postanesthetic Shivering Research Articles

Comparative efficacy of intravenous tramadol and traditional blanket coverage in managing postoperative shivering among post-spinal anesthesia patients

Background & Objective: Shivering after general as well as spinal anesthesia is a common phenomenon. Unmanaged post-anesthetic shivering can worsen postoperative pain and patient’s metabolism. Various techniques including inj. tramadol, body warming, and covering have been evaluated to treat this common complication. We aimed to compare the effectiveness of tramadol administration with patient coverage as therapeutic methods for managing post-anesthesia shivering. Methodology: The study enrolled 60 patients who underwent spinal anesthesia. Patients were divided into two groups: Group A received blanket coverage as treatment for shivering, while Group B received intravenous tramadol. Shivering onset time and duration after treatment were measured. Descriptive statistics and chi-square test/independent t-test determined significance, with P < 0.05 considered statistically significant. Results: The findings of this study revealed no significant difference in the onset of shivering between patients who received intravenous tramadol and those who were covered by blankets (39.83 ± 13.21 min vs 38.60 ± 13.48 min). However, the duration of shivering after treatment was significantly shorter in patients who received intravenous tramadol compared to those who received blanket, e.g., 20.30 ± 9.62 vs. 34.83 ± 12.53; P < 0.000). Conclusion: In conclusion, intravenous tramadol is more effective than non-pharmacological methods (blankets) in managing shivering. Tramadol treatment resulted in a significantly shorter duration of shivering. Keywords: Postoperative Shivering; Hypothermia; Spinal Anesthesia; Tramadol; Blanket Citation: Hwisa SA, Alnaeli GR, Ajaj ARI, Faraj MM, Almghairbi DSE, Alhuwayj KAO, Mohammed LA. Comparative efficacy of intravenous tramadol and traditional blanket coverage in managing postoperative shivering among post-spinal anesthesia patients. Anaesth. pain intensive care 2024;28(5):922−926; DOI: 10.35975/apic.v28i5.2565 Received: May 28, 2024; Reviewed: June 03, 2024; Accepted: Jun 18, 2024Blanket

Prevention of post-anaesthetic shivering under subarachnoid block for lower limb surgeries: A randomised controlled study comparing nefopam and tramadol

Prevention of post-anaesthetic shivering under subarachnoid block for lower limb surgeries: A randomised controlled study comparing nefopam and tramadol

Description of Post Anesthetic Shivering (PAS) in Post Spinal Anesthesia Caesarean Section

Description of Post Anesthetic Shivering (PAS) in Post Spinal Anesthesia Caesarean Section

THE RELATIONSHIP BETWEEN AGE AND DURATION OF SURGERY WITH THE INCIDENCE OF POST ANESTHESIA SHIVERING IN SECTION CAESAREAN PATIENTS AT BENDAN HOSPITAL PEKALONGAN CITY

Background: Shivering is a physiological response to exposure to cold and the body's next steps to maintain heat after peripheral vasoconstriction. The incidence of shivering is caused by several factors including age and length of surgery. Postanesthesia shivering is involuntary oscillatory muscle activity during early recovery after anesthesia. Objective: This study aims to determine the relationship between age and duration of surgery with the incidence of shivering after anesthesia in caesarean section patients at Bendan Hospital, Pekalongan City. Methods: This research includes quantitative research with the type of analytical correlational observational research with a cross sectional approach. The subjects or samples used were 50 caesarean section patients. Determination of subjects was carried out using consecutive sampling technique. Data collection was carried out using an observation sheet for the degree of shivering. Result: Based on the research, the results of the Spearman rank test were obtained with a value of (p) 0.0004 < 0.05 between age and the incidence of shivering and p 0.000 < 0.05 between the length of operation and the incidence of shivering. Conclusion: The conclusion of this study is that there is a relationship between age and length of operation and the incidence of post-anesthesia shivering in caesarean section patients.

Effect of Hot Pack Administration on Shivering in Post Sectio Caesarea Patients with Spinal Anesthesia

The impact that often arises after spinal anesthesia in post-cesarean section patients is shivering which is characterized by fasciculations of the skeletal muscles in the face, head, jaw, trunk or extremities that last more than 15 seconds. The incidence of post-anesthesia shivering in patients undergoing spinal anesthesia reaches 33-56.7%. Giving hot packs has been proven to be effective in treating hypothermia in post-cesarean section patients. Heat therapy using hot packs will restore body temperature quickly. This study aims to identify the effect of giving hot packs with shivering. The research design was pretest posttest control group design with 32 respondents, consisting of 16 treatment groups and 16 control groups taken by accidental sampling. This research was conducted in January 2020 in the High Care Unit Room, Aminah Islamic Hospital, Blitar. The results of this study showed that the administration of shivering scale hot packs in the treatment group decreased significantly to 0 while the control group experienced a less significant decrease in the shivering scale, namely to 1. Statistical test This study used Mann Whitney with a p-value of 0.000. This means that giving hot packs has an effect on shivering in post sectio caesarea patients with spinal anesthesia. Hot packs can be used asalternative therapy to reduce shivering in post sectio caesarea patients with spinal anesthesia

Factors Influence Shivering Phenomenon Post Spinal Anesthesia

Background: Shivering is a prevalent complication encountered by patients following anesthesia. The incidence of shivering after anesthesia can be influenced by factors such as age and the temperature of the operating room. The aim of this study was to compare the occurrence of shivering during surgical procedures among patients who experienced no shivering and those who did. Methodology: data from 60 patients who underwent spinal surgery under anesthesia. We divided them into two groups: 30 without shivering (Group A) and 30 treated with tramadol for shivering (Group B). Results: incidence of shivering among younger patients (<30 years of age). Furthermore, shivering was observed during blood transfusion, and high incidence with patient had undergone a cesarean section (36.7%), in those who received cold liquid during the operating (73.3%), and in those who had not undergone previous surgery (73.3%). Moreover, there were significant correlations between shivering and factors such as age, temperature range during and after the operation (°C), and the condition of the administered liquid during the procedure. Conclusion: the occurrence of post anesthesia shivering in relation to various demographic and procedural factors. The range of age and temperature during and after the operation showed a significant association with the incidence of shivering.

Effectiveness of Prophylactic Ketamine on Shivering in Cesarean Section after Spinal Anesthesia

Background: Regional anesthesia, including spinal or epidural techniques, can disrupt the body's ability to regulate temperature, leading to a heightened risk of shivering. Studies have indicated that shivering occurs in up to 55% of patients undergoing procedures under regional anesthesia. To address this issue, numerous medications have been explored for their potential to prevent post-anesthetic shivering. Objective: To assess the effectiveness of prophylactic ketamine on shivering in cesarean section after spinal anesthesia. Study Design: Prospective, randomized, double blind, clinical trial. Settings: Department of Anesthesiology, Surgical Intensive Care Unit and Pain Management, Civil Hospital Karachi Pakistan. Duration: Six months from August 2019 to January 2020. Methods: A total of 60 patients undergoing spinal anesthesia for elective cesarean section were included in this study. Two groups A and B were formed and patients were equally divided into these groups by lottery method. Group A were treated with ketamine 0.5 mg/kg I/V and group B treated with normal saline 0.05ml/kg/I/V. Grade 0-1 shivering was labeled as effective and shivering grade 2, 3 or 4 at 15 minutes after administration of the drug, was considered ineffective. Results: The average age of the patients was 28.33 ± 5.67 Years. Rate of shivering was significantly high in patients who were treated with normal saline than ketamine in which shivering was not observed (53.3 vs. 0% respectively; P value of 0.0005). This implies that effectiveness was significantly high in groups A than group B (100% vs. 46.7%). Conclusion: Ketamine observed to be the effective drug for the treatment of postanesthetic shivering. It should be considered prophylactically in any patient undergoing spinal anesthesia.

Focal hand warming for post-anaesthesia shivering control: A simple and safe non-pharmacological approach in resource limited-area.

Post-anaesthesia shivering is a common complication and has multiple deleterious effects. Sometimes multiple non-pharmacological interventions applied together may not control post-anaesthesia shivering adequately, necessitating the use of drugs in some cases. Hand warming is commonly used to warm up the body since time immemorial but its role in preventing post-anaesthesia shivering has not been evaluated. This case series describes the application of this simple and safe method of focal hand warming along with other non-pharmacological measures to suppress post-anaesthesia shivering, whereby possible use of drugs could be avoided.

Comparison of Preemptive Effect of Intravenous Ketorolac Versus Nalbuphine on Postoperative Shivering and Pain in Patients Undergoing Surgery Under Spinal Anesthesia: A Prospective, Randomized, Double-Blind Study.

Postoperative pain and postanesthesia shivering are the two common problems in patients undergoing surgery under spinal anesthesia (SA). The present study aimed to compare the preemptive prescription of the single dose of intravenous (IV) ketorolac versus nalbuphine on postoperative shivering and pain in patients undergoing surgery under SA. Present study was a prospective, randomized double-blind study, conducted on patients of either gender, with American Society of Anesthesiologists physical status class I or II, aged 21-60 years, posted for elective lower abdominal surgeries under SA. Patients were randomized by computer-generated random numbers into two groups of 50 patients each: group N (received 0.2 mg/kg nalbuphine IV) and group K (received 0.5 mg/kg ketorolac IV). The incidence of postoperative shivering was 22 % and 36 % in groups N and K respectively and the difference was statistically significant. The first request for analgesia (minutes) was later in group N (295.17 ± 54.62) than in group K (223.80 ± 15.34) and the difference was statistically significant. Increased total analgesic consumption was noted more in group K (131.34 ± 43.27) than in group N (79.23 ± 21.34), and the difference was statistically significant (P < 0.0001). The incidence of side effects was comparable among both groups. Preemptive nalbuphine had less incidence of postoperative shivering, delayed first request for analgesia, and less total analgesic consumption than ketorolac in patients undergoing surgery under SA.

EFFECT OF ONDANSETRON IN MITIGATION OF POST-OPERATIVE SHIVERING IN COMPARISON TO FORCED AIR WARMER AND DEXAMETHASONE IN PATIENTS UNDERGOING INFRA UMBLICAL SURGERIES UNDER SUBARACHNOID BLOCK - A PROSPECTIVE RANDOMISED STUDY

Background: Subarachnoid block in a ubiquitous technique used in the field of anaesthesia to facilitate any number of surgeries below the level of the umbilicus. However, this technique is frequently associated with post anaesthesia shivering caused by the sympathetic blockade and peripheral vasodilatation. Materials and Methods:We compared the efficacy of Ondansetron against dexamethasone and isolated forced air warming in the mitigation of sub arachnoid blockade induced shivering. We enrolled a total of 120 individuals scheduled to undergo elective infra umbilical surgeries and randomly allocated them into three groups designating each other to receive Dexamethasone (Group D), Ondansetron (Group O) and Forced air warming (Group W). we compared the three group inn respect to pre operative and post operative temperature and onset of shivering. Shivering was graded according to the Crossley Mahajan Scale. Results: We found that the statistical analysis yielded comparable results in term of demographic parameters and no statistical significance among the three group with respect to mitigation of Shivering(Chi square value = 8.5, P = 0.075).

Efficacy of intravenous nalbuphine for managing post-anaesthesia shivering: A systematic review and meta-analysis of randomised controlled trials with trial sequential analysis.

Post-anaesthesia shivering is distressing and is observed after spinal and general anaesthesia. Nalbuphine, a partial mu-opioid receptor antagonist with kappa-opioid receptor agonist properties, has been successfully used to manage post-anaesthesia shivering. After registering the review with the International Prospective Register of Systematic Reviews (PROSPERO), we searched PubMed/Medline, Scopus, Ovid, Cochrane Library and clinicaltrials.gov with keywords for randomised controlled trials. The risk of bias-2 (RoB-2) scale was used to assess the quality of evidence. We also used Grading of Recommendations, Assessment, Development and Evaluations (GRADE) guidelines to evaluate the strength of evidence and trial sequential analysis to validate the conclusions. Of the 240 articles, 10 were considered eligible for review (700 patients, 350- nalbuphine, 350- control or placebo). When compared to placebo, the success rate of nalbuphine controlling shivering was significantly better (risk ratio [RR]: 2.37, 95% confidence interval [CI]:1.91, 2.94; P = 0.04, I² = 94%), but comparable to the control group drugs (opioids, dexmedetomidine, ondansetron, pethidine). Compared to placebo, shivering recurrence was significantly less with nalbuphine than with placebo (RR: 0.47, 95% CI: 0.26, 0.83; P = 0.01, I² = 61%), but comparable with the control group. The incidence of postoperative nausea/vomiting (PONV) was significantly less with nalbuphine when compared to the control group (RR: 0.67, 95% CI: 0.47, 0.95; P = 0.02, I² = 37%), but PONV in the nalbuphine group was comparable to placebo (RR: 1.20, 95% CI: 0.68, 2.12; P = 0.54, I² = 0%). Other outcomes, like the grade of shivering and hypotension, were comparable between the nalbuphine and control groups. Nalbuphine successfully controls post-anaesthesia shivering and reduces the recurrence of shivering.

Comparison of Preemptive Post-Intubation 15 Mg/KgBW Paracetamol to 0.35 Mg/KgBW Meperidine in Incidence of Post-Anesthetic Shivering

Post anesthesia shivering (PAS) is a repetitive involuntary movement of one or more muscle groups as a result of a decrease in core body temperature. Pharmacological therapy in preventing PAS may include meperidine and paracetamol. This study compared the effectiveness of paracetamol to meperidine in reducing the incidence of post-anesthesia shivering. This study used an experimental randomized double-blind comparative analytic design on patients underwent exploratory laparotomy surgery under general anesthesia at Dr. Hasan Sadikin General Hospital Bandung, Indonesia, from September 2021 to August 2022. Patients with 50 ASA 1-2 physical status were included and divided into two groups. One group received 15 mg/kg group paracetamol and the other received 0.35 mg/kg meperidine. Data on tympanic membrane temperature and hemodynamics before and after induction and after extubating were collected. Furthermore, data on the results of the assessment of the incidence and grade of shivering in each treatment group were also collected. The results of this study showed that there was a decrease in the frequency of PAS in patients receiving intravenous 15 mg/kg paracetamol (p&lt;0.05), as well as less side effects in the form of nausea and vomiting (p &lt; 0.05). The incidence and degree of shivering after general anesthesia using intravenous 15 mg/kg paracetamol was lower compared to the use of 0.35 mg/kg meperidine. In the meperidine group, the decrease in body temperature was lower than in the paracetamol group, while the incidence of nausea and vomiting in the paracetamol group was lower than in the meperidine group. In conclusion, paracetamol reduces the incidence of post-anesthesia shivering better than meperidine.

Efficacy of dexmedetomidine in the prevention and treatment of postanesthetic shivering after cesarean section

Purpose: To assess the efficacy of dexmedetomidine in the prevention and treatment of postanesthetic shivering in cesarean section.Methods: A total of 144 pregnant women who underwent anesthesia for cesarean section between March and December 2022 were randomly divided into the study group (n = 72) and control group (n = 72). The pregnant women were given combined spinal-epidural anesthesia. Following childbirth, those in the study group were given dexmedetomidine, while those in the control group were given normalsaline. The dose of spinal anesthesia was administered based on the following criteria: intraoperative infusion, atropine usage, ephedrine usage, intraoperative bleeding, intraoperative dosage, mean arterial pressure, heart rate, blood oxygen saturation, incidence of shivering, and sedation score. Incidence of adverse reactions were recorded and compared between the two groups.Results: Intraoperative infusion volume, bleeding volume, levels of atropine and ephedrine usage, and spinal anesthesia dose were similar between the two groups (p &gt; 0.05). At 10 min post-treatment, the study group had lower mean arterial pressure, heart rate and incidence of postanesthetic shivering, as well as higher postoperative sedation score than the control group. Compared with the control group, the study group had slightly higher incidence of pregnancy-related adverse reactions, but the difference was non-significant.Conclusion: Dexmedetomidine has good efficacy in preventing and treating postanesthetic shivering in cesarean section patients. However, further clinical trials are required prior to its adoption in clinical practice.

Comparison of granisetron 10 µg/kg vs 40 µg/kg intravenous for prophylaxis of shivering after spinal anesthesia for lower abdominal surgery

Background &amp; Objective: Postanesthetic shivering is one of the many complications during recovery that is marked by vasoconstriction and involuntary movements in several muscle groups and psychologically is an incredibly uncomfortable experience for the patient. The 5-HT3 receptor antagonist granisetron can potentially be used to manage postanesthetic shivering through the thermoregulation neurotransmission system. This study aims to compare the effects of administering 10 µg/kg or 40 µg/kg of granisetron intravenously on the grade of shivering post spinal anesthesia in lower abdominal surgeries. Methodology: This study was a single-blind experimental study conducted on 30 patients who underwent spinal anesthesia for lower abdominal surgeries in Dr. Hasan Sadikin Hospital Bandung. There were no statistical differences of age, weight, height, BMI, core temperature before anesthesia, block height, room temperature, total bleeding, input volume, duration of surgery, and use of ephedrine between the two intervention groups. Results: Administration of 40 µg/kg intravenous granisetron could maintain the body temperature above 36.56 °C , better than the 10 µg/kg intravenous granisetron with the lowest temperature at 35.31 °C. Regarding the grade of shivering, administration of 40 µg/kg granisetron IV was able to improve postanesthetic shivering up to grade 2 in 3 (20%) patients, while 10 µg/kg intravenous granisetron improved grade of shivering to grade 3 in 5 (33%) patients, these results were statistically significant (P &lt; 0.05). Conclusion: In conclusion, administration of granisetron 40 µg/kg IV reduces the incidence and severity of shivering post spinal anesthesia, and maintains a better core temperature compared to granisetron 10 µg/kg IV.Keywords: 5-Ht3 Receptor Antagonist; Granisetron; Postanesthetic Shivering; Prophylaxis&#x0D; Citation: Wahid WR, Pradian E, Prihartono MA. Comparison of granisetron 10 µg/kg vs 40 µg/kg intravenous for prophylaxis of shivering after spinal anesthesia for lower abdominal surgery. Anaesth. pain intensive care 2023;27(4):553−557; DOI: 10.35975/apic.v27i4.2265&#x0D; Received: October 20, 2021; Reviewed: March 19, 2023; Accepted: June 22, 2023

INTRATHECAL DEXMEDETOMIDINE USE IN SHIVERING PREVENTION: A SYSTEMATIC REVIEW OF RANDOMIZED CLINICAL TRIALS

Shivering is a common postoperative complication and can lead to important interferences in monitorization, in addition to causing discomfort to the patient and increased oxygen consumption. Although frequently related to hypothermia, it can occur in normothermic patients, a fact that raises the importance of using pharmacological strategies for its prophylaxis and treatment. The effectiveness of alpha-2 agonists in preventing this entity has been extensively studied, mainly dexmedetomidine due to its greater selectivity to alpha-2 receptors. Many studies have shown that its intravenous infusion is capable of preventing post-anesthetic shivering, however its use has been questioned due to its possible side effects. Intrathecal administration, on the other hand, has been evaluated as an effective adjuvant drug to local anesthetics. Therefore, this study aims to review the evidence of the intrathecal use of dexmedetomidine as an adjuvant drug in spinal anesthesia to prevent shivering. A search was performed in the MEDLINE database accessed through PubMed and Biblioteca Virtual em Saúde (BVS), which resulted in seven randomized clinical trials presented in this work. They show a significant reduction in the incidence and intensity of shivering after spinal block with the use of five micrograms of intrathecal dexmedetomidine, in addition to promoting an increase in the duration of motor and sensory blocks. However, further studies are still needed to ensure that the hemodynamic repercussions are not significant.

Pharmacologic interventions for the therapy of postanesthetic shivering in adults: a systematic review and network meta-analysis.

Shivering is a common side effect after general anesthesia. Risk factors are hypothermia, young age and postoperative pain. Severe complications of shivering are rare but can occur due to increased oxygen consumption. Previous systematic reviews are outdated and have summarized the evidence on the topic using only pairwise comparisons. The objective of this manuscript was a quantitative synthesis of evidence on pharmacological interventions to treat postanesthetic shivering. Systematic review and frequentist network meta-analysis using the R package netmeta. Endpoints were the risk ratio (RR) of persistent shivering at one, five and 10 minutes after treatment with saline/placebo as the comparator. Data were retrieved from Medline, Embase, Central and Web of Science up to January 2022. Eligibility criteria were: randomized, controlled, and blinded trials comparing pharmacological interventions to treat shivering after general anesthesia. Studies on shivering during or after any type of regional anesthesia were excluded as well as sedated patients after cardiac surgery. Thirty-two trials were eligible for data synthesis, including 28 pharmacological interventions. The largest network included 1431 patients. The network geometry was two-centered with most comparisons linked to saline/placebo or pethidine. The best interventions were after one minute: doxapram 2 mg/kg, tramadol 2 mg/kg and nefopam 10 mg, after 5 minutes: tramadol 2 mg/kg, nefopam 10 mg and clonidine 150 µg and after 10 minutes: nefopam 10 mg, methylphenidate 20 mg and tramadol 1 mg/kg, all reaching statistical significance. Pethidine 25 mg and clonidine 75 µg also performed well and with statistical significance in all networks. Nefopam, tramadol, pethidine and clonidine are the most effective treatments to stop postanesthetic shivering. The efficacy of doxapram is uncertain since different doses showed contradictory effects and the evidence for methylphenidate is based on a single comparison in only one network. Furthermore, both lack data on side effects. Further studies are needed to clarify the efficacy of dexmedetomidine to treat postanesthetic shivering.

Pattern and outcome of Anaesthesia techniques in patients presenting with pre-eclampsia/eclampsia for caesarean section in a Teaching Hospital

Objectives: To review the pattern of anaesthesia techniques among pregnant women with pre-eclampsia or eclampsia who had caesarean section in our health facility and their management outcomeMethods: A retrospective analysis was undertaken for all the obstetric patients with pre-eclampsia or eclampsia who had caesarean sections under different types of anaesthesia in a tertiary hospital between January 1st 2014 and December 31st 2018.Results: A total of one hundred and eighty-two patients who presented with pre-eclampsia and eclampsia had emergency caesarean sections. Of these, 134 (74%) were diagnosed pre-eclampsia and 48 (26%) had eclampsia. The mean age was 29.71±6.40years. Subarachnoid block was performed in 165 (90.66 %), 15 (8.24 %) had general anaesthesia relaxant technique, and the remaining two (1.10 %) had local anaesthetic infiltration ± total intravenous anaesthesia. Peri-operative anaesthetic complications encountered included post-anaesthetic shivering 19 (10.44%), hypotension 16 (8.79 %) and nausea 1 (0.55 %). Incidence of death on table was six percent (11 patients). Among those that died, the anaesthesia technique was general anaesthesia in eight cases (73%) while three patients (27%) had subarachnoid blocks.Conclusion: Spinal anaesthesia was the most commonly used anaesthesia technique in this centre for patients with pre-eclampsia and conscious eclamptic patients, and it proved to be a relatively safe technique with few mortality.

Pethidine Versus Tramadol for Post-Anaesthetic Shivering Control in Patients Going Through Elective Surgery under Spinal Anaesthesia

Objective: To assess the efficacy of Pethidine versus Tramadol in controlling shivering after spinal anaesthesia in patients selected for lower limb surgery.&#x0D; Study Design: Quasi-experimental study&#x0D; Place and Duration of the Study: Department of Anaesthesiology, Combined Military Hospital, Multan Pakistan, from Jun 2019 to Dec 2020.&#x0D; Methodology: Seventy-four individuals (aged: 18 to 65 years) selected through non-probability consecutive sampling for elective lower limb orthopaedic procedures under spinal anaesthesia were included in the study. The patients were distributed among two groups through computer-generated random numbers to receive Tramadol at a dose of 0.5 mg/kg (Group-T) or Pethidine at 0.5 mg/kg (Group-P). The frequency of post-anaesthetic shivering was recorded in all patients.&#x0D; Results: The average age of patients in Groups T and P were 30.2 ± 9 years and 34.5 ± 10 years, respectively. Fifty (67.6%) patients were males, while 24(32.4%) were females. Post-anaesthetic shivering was reported in 37(78.7%) patients in the Tramadol- Group compared to 26(96.3 percent) patients in the Pethidine- Group (p = 0.041).&#x0D; Conclusion: Tramadol caused less post-anaesthetic shivering than Pethidine after spinal anaesthesia in our sample of patients undergoing lower limb surgery.

EFFECT OF NALBUPHINE AND TRAMADOL IN POST-SPINAL ANAESTHESIA SHIVERING: A COMPARATIVE STUDY

Background: In Spinal anaesthesia, a consequence of impaired thermoregulatory control, shivering is one of the most frequently reported complications of central neuraxial blockade, affecting 40–70% of patients. Nalbuphine is a mixed opioid agonist–antagonist with high afnity for the opioid receptor that functions as both a competitive opioid antagonist and a partial opioid agonist. Theoretically, nalbuphine could have signicant anti-shivering effects on post-anaesthetic shivering. This prospecti Methods: ve randomised (computer-generated) double-blinded study was conducted at Department of Anaesthesiology and Intensive Care, Government Medical College Jammu J&amp;K, after obtaining approval from hospital ethical committee. Randomisation was done using a computer-generated number where patients were randomly allocated into two groups: Group-N and Group-T. We conned our investigation to 84 patients divided into two equal groups of 42 people. The non- Results: signicant difference was observed in age, gender, BMI, ASA physical status, duration of surgery, and duration of spinal anesthesia between the groups. The drug was found to signicantly reduce SBP, increase DBP, and increase MAP in the group given the drug compared to the nalbuphine group. The time taken to control shivering was signicantly shorter in the group-T. The group-T also had a lower Ramsay Sedation Scale score, indicating less sedation compared to the group-N group. The drug did not cause any adverse effects, while sedation, hypotension, and bradycardia were observed in the group-N. Nausea, vomiting, and dizziness were reported in the group-T, but not in the group-N. There was no signicant difference in the effectiveness of shivering control between the two groups. Both i Conclusion: ntravenous nalbuphine 0.05 mg/kg and tramadol 1 mg/kg are effective in managing post-spinal anesthesia shivering. However, tramadol had a shorter time to control shivering than nalbuphine. Both drugs had minimal effects on blood pressure and heart rate, and the side effects observed were minor and treatable

A study on the effect of preoperative warming on post-induction core temperature and incidence of postoperative shivering in patients under general anesthesia

BackgroundInadvertent perioperative hypothermia (IPH) defined as core temperature below 36.0 °C is a common complication of general anesthesia with prevalence up to 70%. Warming of peripheral tissues prior to induction of anesthesia reduces the central to peripheral temperature gradient, thereby minimizing central heat loss due to heat redistribution, after induction of anesthesia. This study aimed to evaluate the effect of prewarming on post-induction core temperature and incidence of perioperative inadvertent hypothermia leading to postanesthetic shivering (PAS) in patients undergoing general anesthesia.This is a single-arm study performed after authorization from the scientific review committee (IRB no.:10/2015/05) in a cohort of patients between the ages of 18 and 65 years in ASA I and II physical status, undergoing GA for elective surgeries lasting less than 3 h. Rates of IPH and PAS in 60 patients who were warmed before anesthesia over a 30-min period with a forced-air warmer set at 38.0 °C were compared with existing data from an equal number of cohorts who received only intraoperative warming, during similar surgical procedures according to routine GA.Comparisons between the two groups were made using the Student’s t-test and chi-square test. A paired t-test or Wilcoxon’s signed rank test was applied for pairwise comparisons. The results were considered statistically significant when the P-value was < 0.05.ResultsThe mean decrease in core temperature in the unwarmed group was 0.7 °C (+ /- 0.23) compared with a 0.2 °C decrease (+ /- 0.06) in the prewarmed group of patients. A total of 31.70% of patients in the unwarmed group developed IPH compared with one patient (1.7%) in the prewarmed group shortly after onset. Twenty-six patients (43.30%) in the unwarmed group had hypothermia at the end of surgery, compared with one patient (1.7%) in the prewarmed group. Shivering was observed in 46% of patients in the unwarmed group, while no shivering was observed in the prewarmed group.ConclusionsPreoperative warming is an effective intervention to reduce the frequency of core temperature drops after induction of anesthesia, thereby preventing inadvertent perioperative hypothermia and the incidence of postoperative shivering.