KETAMINE, CLONIDINE AND TRAMADOL FOR CONTROL OF SHIVERING UNDER NEURAXIAL ANESTHESIA

Dr. Ketki Jandial*

ABSTRACT

Background: Shivering tends to increase expenditure of cardiac and systemic energy, and interferes with pulse rate, blood pressure (BP) and electrocardiographic (ECG) monitoring. It also interferes with haemodynamic monitoring intraoperatively. Shivering per se may aggravate post-operative pain, simply by stretching of surgical incision. Therefore, the present study was done to assess the efficacy of ketamine, clonidine and tramadol when used prophylactically to control shivering under neuraxial blockade. Methods: A double blind randomized clinical trial study was performed in the Department of Anesthesia, GMC Jammu, on 144 patients of ASA grade 1 and 2, belonging to either gender or age between 18 to 65 years, after taking written- informed consent. Patients, undergoing lower abdominal or lower limb surgery were included in the study. Results: Ketamine had significant role in sedation degrees as compared to other groups and maintained cardio-respiratory stability and prevented recall of un-pleasant events in the surgery. There was a greater fall in core body temperatures in the placebo group as compared with the ketamine, tramadol and clonidine groups in our study. The incidence of shivering was 23/32 (71.8%) in the placebo group. Conclusion: Ketamine 0.5 mg/kg, clonidine 75 mcg or tramadol 0.5 mg/kg i.v. prophylactically just before neuraxial blockade significantly decreased the incidence of shivering without causing any major side-effects. Using ketamine may be more beneficial as it improves the hemodynamic profile and sedates the patient effectively, which increases patient comfort during surgery, maintains cardiorespiratory stability and prevents recall of unpleasant events during the surgery.

Keywords: Shivering, Ketamine, Clonidine, Tramadol, Neuraxial Blockade.