Role of butorphanol and ondansetron premedication in reducing postoperative shivering after general and spinal anesthesia: A randomized comparative study from North India

Abstract

Background:Postoperative shivering (PAS) is a common problem following general and spinal anesthesia and may lead to multiple complications. This placebo-controlled, randomized study was performed to evaluate the efficacy of Ondansetron and butorphanol premedication reduces shivering after general and spinal anaesthesia.Aims:The aim of this study to highlight the efficacy of Butorphenol and ondosteron in controlling postoperative shivering.Materials and Methods:This clinical trial included 180 patients scheduled for elective general surgery, E.N.T., Ophthamological operations, randomly divided to six groups. Three groups in which General Anaesthesia was used i.e. Group 1-ondansetron 8 mg intravenously(IV).Group 2 butorphanol 2 mg IV and Group 3 – saline 4 ml IV. And three groups where spinal Anaesthesia was used i.e. Group 4-Ondosteron 8 mg IV, Group 5 butorphanol 2 mg IV and Group 6 – saline 4 ml IV 3-5 minutes before anaesthesia. Patients were observed in terms of vital signs, side effects and shivering.Settings and Design:The type of the study was double blind randomized trial.Statistical Analysis Used:Statistical Package for Social Sciences version 13.0 statistical analysis software.Results:Postoperative shivering was observed in 15.5%, 22.2% and 60% in general anaesthesia groups I II and III respectively. The reduction of core and dermal temperature during the anaesthesia and recovery, changes in systolic and diastolic blood pressure and heart rate were similar in all three groups (i.e. Group I,II,III). In spinal anaesthesia groups, PAS occurred 10%, 13.3% and 43.3% in group IV, V, VI respectively. The reduction of core temperature is similar in all three groups of spinal anaesthesia. But heart rate and mean arterial pressure increase were significant in control saline group in post operative recovery time. No complication seen in any of the six groups.Conclusion:This study suggested that use of Butorphanol and Ondansteron both are effective in reducing the incidence of PAS after general and spinal anaesthesia.

Efficacy of intravenous ondansetron for prevention of postspinal shivering during lower segment cesarean section: A double-blinded randomized trial

“…[18] Nausea and vomiting was observed in 19/40 patients (47.5%) in the normal saline group while 2/40 patients (5%) in the ondansetron group. Owczuk et al .…”

Comparison of the Effects of Intrathecal Meperidine and Morphine on Incidence and Intensity of Shivering After Caesarean Sections Under Spinal Anesthesia: A Randomized Controlled Trial

“…One of the known effects of intrathechal opioids is the prevention and treatment of postoperative shivering (3,5,7). However, the safety of this practice is not completely stabilized.…”

“…Perioperative shivering leads to patient uneasiness, more postoperative bleeding, higher blood pressure, tachycardia, more oxygen consumption, more carbon dioxide production, increased metabolic rate by fourfold, and may disturb the functioning of monitoring devices during anesthesia (5,6).…”

Intravenous injection of butorphanol prevents shivering of parturients undergoing cesarean section under epidural anesthesia: a randomized controlled trial

“…In Bansal's study (5), the administration of intravenous butorphanol 1 mg used for treatment stopped 83% of shivering. In Rai's study (15) , the incidences of postoperative shivering were reduced from 60% to 15.5% in the general anesthesia group and from 43.3% to 10% in the spine anesthesia group by the administration of intravenous butorphanol 2 mg before anesthesia. In this study the incidences of shivering during cesarean section under epidural anesthesia were reduced from 34.2% to 10.5% and 12.5% respectively with the administration of intravenous butorphanol 7.5 μg/kg and 5 μg/kg before administering anesthesia, but there was no significant difference in the incidences of shivering between the groups receiving butorphanol.…”

“…Butorphanol is an easily available opioid acting through κ and μ receptor. A few studies have denoted its anti-shivering properties (5,15). In Bansal's study (5), the administration of intravenous butorphanol 1 mg used for treatment stopped 83% of shivering.…”