Comparison between alfentanil, pethidine and placebo in the treatment of post-anaesthetic shivering

Abstract

We have compared the effects of pethidine, alfentanil and placebo in the treatment of post-anaesthetic shivering. Ninety patients who shivered after routine surgery were allocated randomly to receive normal saline (n = 30), alfentanil 250 micrograms (n = 30) or pethidine 25 mg (n = 30). After 10 min, 26 patients had stopped shivering in the pethidine group which was significantly more than the incidence in the two other groups (placebo = 7; alfentanil = 12) (P < 0.0002). Alfentanil was not significantly different from normal saline in affecting shivering. We conclude that alfentanil 250 micrograms was not effective in the treatment of post-anaesthetic shivering.

A Randomised Trial Comparing Efficacy, Onset and Duration of Action of Pethidine and Tramadol in Abolition of Shivering in the Intra Operative Period

“…The difference was statistically significant (p<0.05). The findings were in consolence with other studies by Write et al, [14] and Wrench et al, [16] which noted 8% with Tramadol group13 and 13-50% in Pethidine group. Thus various studies including ours there was higher rate of recurrence with Pethidine in comparison to Tramadol.…”

Nefopam or clonidine in the pharmacologic prevention of shivering in patients undergoing conscious sedation for interventional neuroradiology

“…An investigator, blinded to the antishivering drug injected, recorded and graded the incidence of visible shivering from its administration until 30 min after the end of the procedure. Shivering was graded on a 5-point scale (Appendix 3) [18]. Nausea, vomiting and sweating were also recorded.…”

Tremores intra e pós-operatório: prevenção e tratamento farmacológico

“…Vários fármacos (meperidina, cetanserina, sufentanil, alfentanil, tramadol, fisostigmina, urapidil, nefopam, doxapram e nalbufina) já foram testados para prevenir ou tratar tremores 7-9, 28,55,56 . A meperidina mostrou ser um dos mais efetivos 56,57 , agindo provavelmente no centro de regulação térmica 55 ou via receptores opióides 15 . É provável que o receptor NMDA também module a regulação térmica em vários níveis 15 .…”

“…Não houve relação entre a temperatura axilar e o tremor 58 . A cetamina é um antagonista NMDA que deve agir contra tremores via termogênese sem tremores, ação no hipotá-lamo ou efeito β-adrenérgico, além de ter algum efeito no receptor κ. Um estudo sugere que a meperidina deve agir contra tremor via receptores κ, pois altas doses de naloxona inibem sua ação (inibem receptores mu e kapa) enquanto pequenas doses de naloxona não o fazem (inibem apenas receptores mu) 56 . A desvantagem da meperidina é o risco de depressão respiratória, náusea e vômito.…”

“…Ketamin is a NMDA antagonist that is effective in the prevention of tremors, probably through the thermogenesis without tremors pathway, by acting on the hypothalamus, or by a β-adrenergic effect, besides having some effect on the κ receptor. A study suggested that the action of meperidine against tremors might be through κ receptors, because high doses of naloxone inhibits its action (high doses inhibit mu and kappa receptors), while small doses of naloxone do not (inhibit only mu receptors) 56 . The disadvantage of meperidine is the risk of respiratory depression, nausea, and vomiting.…”