Comparison of prophylactic dexmedetomidine and ketamine for the control of shivering under spinal anaesthesia
Keywords:Dexmedetomidine, Ketamine, Neuraxial block, Shivering
Background: Shivering is a common problem during neuraxial block. Thermoregulatory control gets compromised by neyraxial block and as a result the incidence of shivering can go up to 56.7%. Aim of the current investigation was to evaluate the effectiveness of prophylactic use of intravenous dexmedetomidine and ketamine for the control of shivering and to note any side-effects of the drugs used during subarachnoid block.
Methods: This randomised single blind study was conducted in 151 ASA grade I and II patients. SAB was performed with 3.0mL (15 mg) of 0.5% bupivacaine heavy in all patients. Patients were randomly allocated into two groups of 75 and 76each to receive dexmedetomidine (0.5 µg/kg) in group D and ketamine (0.5 mg/kg) in group K respectively. Temperature and hemodynamic parameters were recorded at every 15mins interval. Shivering was graded from 0 to 4 according to Tsai and Chu and if grade 3 shivering occurred, the study was stopped and pethidine 25 mg was given intravenously as rescue drug.
Results: 2.67% of patients in group D had shivering whereas 38.16% patients in group K experienced shivering at the 5th minute after spinal anaesthesia and it was statistically significant. However the difference in the incidence of shivering was not statistically significant between the two groups after the initial 5 minutes till the end of surgery.
Conclusions: The prophylactic use of dexmedetomidine reduced incidences of shivering more effectively as compared to prophylactic use of ketamine. None of the drugs caused any untoward side effects.
Norouzi M, Doroodian M.R , Salajegheh S. Optimum dose of ketamine for prevention of postanesthetic shivering; a randomized double-blind placebo-controlled clinical trial. Anaesthesiol Belg. 2011;62 (1):33-6.
Gangopadhyay S, Gupta K, Acharjee S, Nayak SK, Dawn S, Piplai G. Ketamine, tramadol and pethidine in prophylaxis of shivering during spinal anaesthesia. J Anaesthesiol Clin Pharmacol. 2010;26 (1):59-63.
Shakya S, Chaturvedi A, Sah BP. Prophylactic low dose ketamine and ondansetron for prevention of shivering during spinal anaesthesia. J Anaesthesiol Clin Pharmacol. 2010;26(4):465-9.
Aroni F, Iacovidou N, Dontas I, Pourzitaki C, Xanthos T. Pharmacological aspects and potential new clinical applications of ketamine: reevaluation of an old drug. J Clin Pharmacol. 2009;49(8):957-64.
Kamal MM, Hussein NS. Prevention of postspinal shivering by using ketamine plus midazolam in comparison with nefopam. Egypt J Anaesthesiol. 2011;27(1):1-5.
Reves JG, Glass P, Lubarsky DA, McEvoy MD, Martinez-Ruiz R. Intravenous anesthetics. In: Miller RD, eds. Miller's Anesthesia. 7th ed. Philadelphia: Churchill Livingstone Elsevier; 2009:742-7.
Elvan EG, Oç B, Uzun S, Karabulut E, Coşkun F, Aypar U. Dexmedetomidine postoperative shivering in patients undergoing elective abdominal hysterectomy. Eur J Anaesthesiol. 2008;25(5):357-64.
Usta B, Gozdemir M, Demircioglu RI, Muslu B, Sert H, Yaldiz A. Dexmedetomidine for the prevention of shivering during spinal anesthesia. Clinics (Sao Paulo). 2011;66(7):1187-91.
Bajwa SJ, Gupta S, Kaur J, Singh A, Parmar S. Reduction in the incidence of shivering with perioperative dexmedetomidine: A randomized prospective study. J Anaesthesiol Clin Pharmacol. 2012;28(1):86-91.
Kim YS, Kim YI, Seo KH, Kang HR. Optimal dose of prophylactic dexmedetomidine for preventing postoperative shivering. Int J Med Sci. 2013;10(10): 1327-32.
Bozgeyik S, Mizrak A, Kılıç E, Yendi F, Ugur BK. The effects of preemptive tramadol and dexmedetomidine on shivering during arthroscopy. Saudi J Anaesth. 2014;8(2):238-43.
Mittal G, Gupta K, Katyal S, Kaushal S. Randomised double-blind comparative study of dexmedetomidine and tramadol for post-spinal anaesthesia shivering. Indian J Anaesth. 2014;58(3):257-62.
Grewal A. Dexmedetomidine: New avenues. J Anaesthesiol Clin Pharmacol. 2011;27:297-302.
Bajwa SJ, Bajwa SK, Kaur J, Singh G, Arora V, Gupta S, et al. Dexmedetomidine and clonidine in epidural anaesthesia: A comparative evaluation. Indian J Anaesth. 2011;55:116-21.
Talke P, Tayefeh F, Sessler DI, Jeffrey R, Noursalehi M, Richardson C. Dexmedetomidine does not alter the sweating threshold, but comparably and linearly decreases the vasoconstriction and shivering thresholds. Anesthesiol. 1997;87:835-41.
Kamibayashi T, Maze M. Clinical uses of alpha2adrenergic agonists. Anesthesiol. 2000;93: 1345-99.
Karaman S, Gunusen I, Ceylan MA, Keramant, Cetin EN, Derbent A, et al. Dexmedetomidine infusion prevents postoperative shivering in patients undergoing gynaecologic laparoscopic surgery. Turk J Med Sci. 2013;43:232-7.
Ikeda T, Kazama T, Sessler DI, Toriyama S, Niwa K, Shimada C, et al. Induction of anesthesia with ketamine reduces the magnitude of redistribution hypothermia. Anesth Analg. 2001;93:934-8.
Sagir O, Gulhas N, Toprak H, Yucel A, Begec Z, Ersoy O. Control of shivering during regional anaesthesia: Prophylactic ketamine and granisetron. Acta Anaesthesiol Scand. 2007;51:44-9.
Dal D, Kose A, Honca M, Akinci SB, Basgul E, Aypar U. Efficacy of prophylactic ketamine in preventing postoperative shivering. Br J Anaesth. 2005;95:189-92.
Honarmand A, Safavi MR. Comparison of prophylactic use of midazolam, ketamine, and ketamine plus midazolam for prevention of shivering during regional anaesthesia: a randomized double-blind placebo controlled trial. Br J Anaesth. 2008; 101(4):557-62.
Kose EA, Honca A, Dal D, Akinci SB, Aypar S. Prophylactic ketamine to prevent shivering in parturients undergoing Cesarean delivery during spinal anesthesia. J Clin Anesth. 2013;25(4):275-80.