A comparative study of intravenous dexmedetomidine and intravenous clonidine for postspinal shivering in patients undergoing lower limb orthopedic surgeries

Abstract

Background:Dexmedetomidine and clonidine have been used for the prevention and treatment of shivering following spinal blockade. A prospective randomized, double-blinded study was conducted to compare the efficacy and safety of dexmedetomidine and clonidine in controlling postspinal shivering.Methods:A total of sixty participants of equal sex, aged between 18 and 60 years of American Society of Anesthesiologists (ASA) I/II Class, who underwent orthopedic lower limb surgeries under spinal anesthesia with ≥Grade III shivering were randomly divided into two groups, Group D (n = 30) received injection dexmedetomidine 0.5 μg/kg and Group C (n = 30) received injection clonidine 1 μg/kg when they experienced shivering. Time taken to control shivering, response rate, recurrence rate, and side effects such as nausea, vomiting, dry mouth, respiratory depression, and deep sedation were observed.Results:The demographic profile, ASA Class, duration of surgery, duration of anesthesia, temperature, onset and grade of shivering were all comparable between the two groups. Time taken to control shivering and recurrence rate were significantly lower in Group D when compared with Group C. Level of sedation was adequate with Group D, and the incidence of hypotension and bradycardia were significantly higher in Group C. The other side effects profiles were comparable between the two groups.Conclusion:Dexmedetomidine 0.5 μg/kg is more efficient than clonidine 1 μg/kg in controlling postspinal blockade shivering. Dexmedetomidine has early onset of effect, high response rate, and less recurrence rate with added advantage of good sedation and stable cardiorespiratory parameters.

Intravenous dexmedetomidine versus intravenous clonidine for post spinal anesthesia shivering: a meta-analysis of randomized controlled trials

“…All included studies compared effective rate of shivering treatment of dexmedetomidine with that of clonidine. [11][12][13][14][15][16] We found both dexmedetomidine and clonidine were effective for shivering treatment with effective rates of 97.6% and 89.4%, respectively; and more patients were effectively treated in the dexmedetomidine groups than the clonidine groups, (OR ¼ 4.11; 95% CI [1.53, 11.07], P ¼ 0.005, I 2 ¼0%) ( Figure 3).…”

Comparative efficacy and safety of intravenous clonidine and tramadol for control of postspinal anesthesia shivering

“…[ 2 ] Opioid receptors, α 2 receptors, and serotonergic receptors are involved in the pathogenesis of shivering. [ 8 ]…”

“…Pharmacological agents acting on the pathways discussed above are useful for the treatment of shivering. [ 8 ] Different pharmacological agents studied for their potential in prevention of peri- or post-operative shivering include clonidine, tramadol, dexmedetomidine, ondansetron, granisetron, ketamine, and pethidine. [ 2 3 10 11 12 13 14 ]…”

Comparative study between intrathecal dexmedetomidine and intrathecal magnesium sulfate in prevention of post spinal shivering in uroscopic surgery. (RCT)

“…Dexmedetomidine is a highly selective alpha-2-adrenoreceptor agonist with potent effects on the central nervous system decreasing the sympathetic tone (5). It has been effectively used intravenously in several studies for treatment (6)(7)(8)(9)(10) and for prevention (11)(12)(13)(14) of shivering following SA without any major adverse effect. Few trials examined intrathecal dexmedetomidine in postspinal shivering prevention (5,15).…”

“…Different drugs that act on these receptors have been examined in different trials for the prevention or treatment of shivering that occurs after SA (4). These drugs include meperidine, fentanyl, clonidine, ketamine, and tramadol, and they have resulted in different degrees of efficacy and many associated side effects like hemodynamic instability, respiratory depression, nausea and vomiting (24).Dexmedetomidine(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15) and magnesium sulphate(2,3,(17)(18)(19)(20) proved efficacy and safety in preventing and treating shivering following spinal anesthesia as equal as, or sometimes superior than, other adjuvants with less adverse effects. Few of these trials(3,5,15,17) examined them intrathecally to prevent related shivering.…”