A Prospective Randomized Double Blind Comparative Study of Clonidine, Dexmedtomidine and Tramadol for Treatment of Shivering Under Spinal Anaesthesia

Shivering is a common problem during spinal anaesthesia. Neuraxial anaesthesia impairs thermoregulatory control and up to a 40–70% incidence of shivering has been reported. The aim of this study was to evaluate and compare the efficacy, potency and side effects of clonidine, dexmedtomidine and tramadol in post-spinal anaesthesia shivering.

A prospective, randomised, and double-blind study was conducted in 90 American Society of Anaesthesiologists Grade I and II patients of either gender, aged between 20 and 50 years, scheduled for various surgical procedures under spinal anaesthesia who developed shivering. The patients were randomised in to three groups of 30 patients each to receive either dexmedetomidine 0.5 μg/kg or clonidine 0.5 ug/kg or tramadol 0.5 mg/kg as a slow intravenous bolus. Onset time of shivering, time for cessation of shivering, recurrence, response rate, and adverse effects were observed at scheduled intervals.

Data among groups was compared using one way ANOVA. The incidence of shivering and side-effects were compared using the chi-square test.

Time taken for cessation of shivering was significantly less with dexmedetomidine and clonidine when compared to tramadol. Response rate was comparable in all the three groups. Nausea and vomiting was observed only in tramadol group (36% and; 26% respectively).

Treatment of post-spinal shivering is faster with dexmedtomidine or clonidine in comparison to tramadol with fewer side effects but dexmedtomidine has an edge over clonidine in being more haemodynamic stable with less adverse effects.