Vyas Varsha, Gupta Rajat, Dubey Prakhar
Department of Anesthesia, D. Y. Patil School of Medicine and Hospital, Navi Mumbai, Maharashtra, India.
Department of Anesthesia, VMMC and Safdarjung Hospital, New Delhi, India.
Anesth Essays Res. 2018 Jul-Sep;12(3):663-668. doi: 10.4103/aer.AER_86_18.
Shivering is a common problem in patients undergoing surgery under spinal anesthesia.
The aim of this study was to compare efficacy and safety of clonidine versus tramadol in postspinal anesthesia shivering.
This prospective, randomized, double-blind controlled clinical trial was conducted in a tertiary care setting.
A total of 60 American Society of Anesthesiologists physical status Class l and II adult patients (age 18-65 years) undergoing surgery under spinal anesthesia and developed shivering received either clonidine 1 μg/kg or tramadol 1 mg/kg intravenously. The time required for cessation of shivering, control and recurrence rate of shivering, effect on hemodynamics and side effects were compared between two groups.
Unpaired -test and Chi-square test were used for comparison of continuous variables and dichotomous data between two groups, respectively. < 0.05 was considered as statistically significant.
Time for cessation of shivering was less in clonidine group than tramadol group (02.51 vs. 04.82 min; < 0.001). Complete control of shivering was achieved in 80% of patients in clonidine group versus 70% in tramadol group. There was no significant difference for control ( = 0.5) and rate of recurrence of shivering between clonidine and tramadol group (06.7% vs. 16.7%; = 0.42). Pulse rate and systolic blood pressure were significantly lower in clonidine group at 5 and 15 min as compared with tramadol. Significantly more number of patients experienced nausea and dizziness (36.7% vs. 0%; < 0.001 and 20% vs. 0%; = 0.01) with tramadol while bradycardia and hypotension were numerically more common in patients receiving clonidine (6.7% vs. 0% and 13.3% vs. 0%).
Clonidine provides early relief from shivering than tramadol with fewer side effects in patients undergoing surgery under spinal anesthesia.
寒战是接受脊髓麻醉手术患者的常见问题。
本研究旨在比较可乐定与曲马多治疗脊髓麻醉后寒战的疗效和安全性。
本前瞻性、随机、双盲对照临床试验在三级医疗机构进行。
总共60例美国麻醉医师协会身体状况分级为I级和II级的成年患者（年龄18 - 65岁），在脊髓麻醉下接受手术并出现寒战，静脉注射可乐定1μg/kg或曲马多1mg/kg。比较两组患者寒战停止所需时间、寒战控制率和复发率、对血流动力学的影响及副作用。
分别采用非配对t检验和卡方检验比较两组间的连续变量和二分数据。P < 0.05被认为具有统计学意义。
可乐定组寒战停止时间比曲马多组短（02.51分钟对04.82分钟；P < 0.001）。可乐定组80%的患者寒战得到完全控制，而曲马多组为70%。可乐定组和曲马多组在寒战控制（P = 0.5）和复发率方面无显著差异（06.7%对16.7%；P = 0.42）。与曲马多组相比，可乐定组在5分钟和15分钟时的脉搏率和收缩压显著更低。使用曲马多的患者出现恶心和头晕的人数显著更多（36.7%对0%；P < 0.001和20%对0%；P = 0.01），而接受可乐定的患者心动过缓和低血压在数值上更常见（6.7%对0%和13.3%对0%）。
在接受脊髓麻醉手术的患者中，可乐定比曲马多能更快缓解寒战，且副作用更少。
