Comparison of clonidine and tramadol for the control of shivering under spinal anaesthesia

Abstract

Objectives: This study aimed to evaluate the relative efficacy of intravenously administered clonidine and tramadol for control of intraoperative shivering following spinal anaesthesia. Materials and Methods: A prospective, randomized, clinical controlled study was conducted on 60 ASA grade-I &II patients of either sex, aged 18-40 years, scheduled for elective lower abdominal and lower limb surgeries, under spinal anaesthesia. Patients who developed post spinal intraoperative shivering of grades 3 or 4, lasting for minimum period of 2minutes were included in the study, and randomly allocated to one of the two groups, group C (n=30), received Inj. clonidine 50µg i.v., and group T (n=30), received Inj. tramadol 50mg i.v. when shivering was observed. Time taken for control of shivering, response rate, recurrence rate, and side effects were observed. Results: The response rate was significantly higher in tramadol group than clonidine group at 1min, 2mins, and 3mins and 5mins intervals and comparable in both groups at 15 mins. The average time taken for disappearance of shivering was higher in clonidine group i.e. 5.76 ± 0.88mins as against 3.16 ± 0.84mins in tramadol group (P=0.038). Patients with incomplete response and recurrence were more in clonidine group. Side effects like hypotension, bradycardia, sedation and dry mouth were observed in clonidine group patients, and nausea and vomiting in tramadol group, but were controllable. Conclusion: Tramadol is better as compared to clonidine for control of intraoperative shivering under spinal anaesthesia due to rapid onset, higher response rate, lesser recurrence, lesser sedation and lesser hemodynamic alterations.

Clonidine versus Tramadol for postanesthetic shivering: a randomized clinical trial study

“…For instance, there was a randomized clinical trial conducted by Prerna Attal et al, on patients undergoing abdominal and lower extremities surgery, to compare the effect of Clonidine and Tramadol on spinal anesthesia-related shivering. Their findings indicated that the time required for stopping shivering and improving the patients' condition was significantly lower in the Tramadol group (3.16±0.84 min) than the Pethidine group (5.76±0.8 min); yet, there was no significant statistical difference between the Tramadol and Clonidine groups in terms of heart rate, systolic blood pressure, and diastolic blood pressure (Attal et al, 2015).…”

Shivering Pós-Anestésico

“…Possível agonista α2 adrenérgico no sistema nervoso central (SNC) e antagonista não competitivo dos receptores NMDA espinhais (GANI, et al, 2016;FERN & MISIRIN, 2015), b) Tramadol (35 a 220mg): inibição da recaptação de 5HT, noradrenalina e dopamina, aumento da liberação de 5HT reduzindo o set point da temperatura corporal. Possível agonista α2.1 (HINDSHOLM, et al, 1992;JAVAHERFOROOSH, et al, 2009;ATTAL, et al, 2015;RASHWAN, et al, 2015;TREKOVA, et al, 2004). c) Outros: agonistas μ (morfina, fentanil, alfentanil).…”