Comparative Study of Granisetron Versus Pethidine for the Prevention of Perioperative Shivering Under Spinal Anesthesia

Authors

  •   Savitri D. Kabade Department of Anesthesiology, Karnataka Institute of Medical Sciences, Hubli, Karnataka
  •   Y. Venkatesh Department of Anesthesiology, Karnataka Institute of Medical Sciences, Hubli, Karnataka
  •   S. L. Karthik Department of Anesthesiology, Karnataka Institute of Medical Sciences, Hubli, Karnataka
  •   Vikas Kumar Department of Anesthesiology, Karnataka Institute of Medical Sciences, Hubli, Karnataka

Keywords:

Granisetron, pethidine, shivering

Abstract

Aims: Shivering, the “big little problem,†has an incidence of 19–33% following spinal anesthesia. Recently, studies showed the involvement of serotonergic system in the control of postanesthetic shivering. Pharmacological management includes opioids (pethidine) and nonopioids like 5‑HT3 receptor antagonists (ondansetron and granisetron). Pethidine which is considered as a time‑tested drug for control of shivering can have adverse effects such as respiratory depression, nausea, and vomiting. This study was performed to compare the effect of prophylactic granisetron versus pethidine in prevention of perioperative shivering in patients under spinal anesthesia. Settings and Design: A prospective randomized, double blinded study was conducted on 60 patients of ASA I and II physical status aged between 20-50 years scheduled for elective lower abdominal surgeries under spinal anesthesia.Subjects and Methods: After obtaining ethical committee clearance and patient consent, sixty American Statistical Association Grade I and II patients, aged 20–50 years scheduled for elective lower abdominal surgeries under spinal anesthesia were recruited for a randomized double‑blinded study divided into Group G and Group P and received intravenous (IV) granisetron 40 mcg/kg and pethidine 0.4 mg/kg, respectively. Perioperatively, vitals and core temperature were monitored and shivering was assessed using 5‑item scale once in every 15 min up to 6 h. Statistical Analysis: The results were analysed using Statistical Package for Social Science software. Results: Of the sixty patients we studied, the demographic profile between the two groups was comparable. Six patients had shivering in each group. The mean temperature at which patient developed shivering was 36.31°C in Group G and 35.85°C in Group P. The mean time of onset for shivering to occur in Group G was 95 min and in Group P was 65 min. None of the patients received rescue drug. Patients in both the groups were hemodynamically stable. Conclusions: Prophylactic granisetron 40 μg/kg IV is as effective as pethidine 0.4 mg/kg IV in preventing perioperative shivering following spinal anesthesia and also reduces the need of antiemetics.

Downloads

Download data is not yet available.

Downloads

Published

2016-01-01

How to Cite

Kabade, S. D., Venkatesh, Y., Karthik, S. L., & Kumar, V. (2016). Comparative Study of Granisetron Versus Pethidine for the Prevention of Perioperative Shivering Under Spinal Anesthesia. Karnataka Anaesthesia Journal, 2(1), 14–18. Retrieved from http://karnatakaanesthesiajournal.in/index.php/kaj/article/view/139104

Issue

Section

Original Articles

References

Iqbal A, Ahmed A, Rudra A, Wankhede RG, Sengupta S, Das T, et al.Prophylactic granisetron vs pethidine for the prevention of postoperative shivering: A randomized control trial. Indian J Anaesth 2009;53:330‑4.

Buggy DJ, Crossley AW. Thermoregulation, mild perioperative hypothermia and postanaesthetic shivering. Br J Anaesth 2000;84:615‑28.

Díaz M, Becker DE. Thermoregulation: Physiological and clinical considerations during sedation and general anesthesia. Anesth Prog 2010;57:25‑32.

Sagir O, Gulhas N, Toprak H, Yucel A, Begec Z, Ersoy O. Control of shivering during regional anaesthesia: Prophylactic ketamine and granisetron. Acta Anaesthesiol Scand 2007;51:44‑9.

Bhattacharya PK, Bhattacharya L, Jain RK, Agarwal RC. Post anaesthesia shivering (PAS): A review article. Indian J Anaesth 2003;47:88‑93.

Vassilieff N, Rosencher N, Sessler DI, Conseiller C. Shivering threshold during spinal anesthesia is reduced in elderly patients. Anesthesiology 1995;83:1162‑6.

Frank SM, El‑Rahmany HK, Cattaneo CG, Barnes RA. Predictors of hypothermia during spinal anesthesia. Anesthesiology 2000;92:1330‑4.

Leslie K, Sessler DI. Reduction in the shivering threshold is proportional to spinal block height. Anesthesiology 1996;84:1327‑31.

Emerick TH, Ozaki M, Sessler DI, Walters K, Schroeder M. Epidural anesthesia increases apparent leg temperature and decreases the shivering threshold. Anesthesiology 1994;81:289‑98.

Wrench IJ, Cavill G, Ward JE, Crossley AW. Comparison between alfentanil, pethidine and placebo in the treatment of post‑anaesthetic shivering. Br J Anaesth 1997;79:541‑2.

Terasako K, Yamamoto M. Comparison between pentazocine, pethidine and placebo in the treatment of post‑anesthetic shivering. Acta Anaesthesiol Scand 2000;44:311‑2.

Koay CK, Chan WY, Chin MK. Shivering during regional anaesthesia and its control with pethidine. Singapore Med J 1991;32:160‑2.

Powell RM, Buggy DJ. Ondansetron given before induction of anaesthesia reduces shivering after general anaesthesia. Anaesth Analg 2000;90:423‑7.

Piper SN, Röhm KD, Maleck WH, Fent MT, Suttner SW, Boldt J.Dolasetron for preventing postanesthetic shivering. Anesth Analg 2002;94:106‑11.

Kim MS, Kim DW, Woo SH, Yon JH, Lee S. Effect of ramosetron on shivering during spinal anesthesia. Korean J Anesthesiol 2010;58:256‑9.

Tsai YC, Chu KS. A comparison of tramadol, amitriptyline, and meperidine for postepidural anesthetic shivering in parturients. Anesth Analg 2001;93:1288‑92.

Katzung BG, Masters SB, Trevor AJ. Basic and Clinical Pharmacology. 11th ed. New York: McGraw‑Hill; 2009. p. 236.

Stoelting RK, Hiller SC. Pharmacology and Physiology in Anaesthetic Practice. 4th ed., Ch. 3. Philadelphia: Lippincott Williams Willing; 2006.p. 102‑4.

Mohammadi SS, Jabbarzadeh S, Movafegh A. Mohammadi SS, Jabbarzadeh S, Movafegh A. Efficacy of granisetron on prevention of shivering, nausea and vomiting during cesarean delivery under spinal anesthesia: A randomized double-blinded clinical trial. J Obstet Anaesth Crit Care 2015;5:22-6.

Sessler DI. Miller’s Anaesthesia. 6th ed., Vol. 1, Ch. 40. Philadelphia: Temperature Monitoring; 2011. p. 1571‑97.

Yokoyama K, Suzuki M, Shimada Y, Matsushima T, Bito H, Sakamoto A. Effect of administration of pre‑warmed intravenous fluids on the frequency of hypothermia following spinal anesthesia for cesarean delivery. J Clin Anesth 2009;21:242‑8.

Camus Y, Delva E, Cohen S, Lienhart A. The effects of warming intravenous fluids on intraoperative hypothermia and postoperative shivering during prolonged abdominal surgery. Acta Anaesthesiol Scand 1996;40:779‑82.

Buggy D, Hughes N. Pre‑emptive use of the space blanket reduces shivering after general anaesthesia. Br J Anaesth 1994;72:393‑6.

Saito T, Sessler DI, Fujita K, Ooi Y, Jeffrey R. Thermoregulatory effects of spinal and epidural anesthesia during cesarean delivery. Reg Anesth Pain Med 1998;23:418‑23.

Kelsaka E, Baris S, Karakaya D, Sarihasan B. Comparison of ondansetron and meperidine for prevention of shivering in patients undergoing spinal anesthesia. Reg Anesth Pain Med 2006;31:40‑5.

Sajedi P, Yaraghi A, Moseli HA. Efficacy of granisetron in preventing postanesthetic shivering. ActaAnaesthesiol Taiwan 2008;46(4):166-70.

Sayed AM, Ezzat SM. Preoperative granisetron for shivering prophylaxis in cesarean section under spinal anesthesia. Ain-Shams J Anaesthesiol 2014;7:151-5.

Kranke P, Eberhart LH, Roewer N, Tramèr MR. Pharmacological treatment of postoperative shivering: A quantitative systematic review of randomized controlled trials. Anesth Analg 2002;94:453‑60.