Comparison of dexmedetomidine, pethidine and tramadol in the treatment of post-neuraxial anaesthesia shivering

Abstract

Objective: This study was performed to compare the effectiveness of intravenous dexmedetomidine with that of pethidine and tramadol in the treatment of post-neuraxial anaesthesia shivering.

Design: This was a prospective, randomised, double-blinded study.

Setting and subjects: One hundred and two patients of both genders, aged 18–70 years with American Society of Anesthesiologists physical status I and II undergoing spinal or combined spinal and epidural anaesthesia for elective surgery were enrolled in this study. Sixty of them developed shivering after an intrathecal injection of 0.5% hyperbaric bupivacaine 15 mg. They were then randomly allocated to receive either intravenous dexmedetomidine 0.5 μg/kg, pethidine 0.5 mg/kg or tramadol 0.5 mg/kg.

Outcome measures: The response rate to treatment, the degree of sedation and the side-effects were recorded.

Results: The response rate to treatment was highest in the dexmedetomidine group, and it was only significant when compared to tramadol group (p = 0.0012). It was noted that the response rate was higher in the pethidine than in the tramadol group. This difference was not statistically significant (p = 0.082). The sedation score post treatment was similar in all three groups, but more patients in the dexmedetomidine group developed hypotension and bradycardia (p < 0.05).

Conclusion: Dexmedetomidine 0.5 μg/ml was more effective than tramadol 0.5 mg/ml and pethidine 0.5 mg/ml, and both tramadol and pethidine were found to have similar efficacy, in the treatment of post-neuraxial anaesthesia shivering. However, dexmedetomidine caused a higher incidence of  hypotension and bradycardia.

Keywords: dexmedetomidine, pethidine, post-neuraxial anaesthesia shivering, tramadol