Abstract

CLINICAL EFFICACY OF INTRAVENOUS BUTORPHANOL, GRANISETRON AND KETAMINE FOR PREVENTION OF POST SPINAL SHIVERING -A COMPARATIVE EVALUATION

*Prof. Gupta Kumkum MD, DA, Dr. Sharma Raaghav MBBS, Dr. Singh Ivesh MD, Dr. Zuberi Azka MD, Prof. Gupta Prashant K. MD, DMRE, FICRI, FIAMS, Dr. Bansal Manoranjan MD.

Abstract

Background and aim- Subarachnoid block is safe anesthetic technique but associated with variable hypotension, bradycardia and shivering. Shivering is a physiological response to core hypothermia in an attempt to raise the metabolic heat production. The present study was aimed to compare the clinical efficacy of intravenous butorphanol, granisetron and ketamine for prevention of post spinal shivering. Patients and Method- One hundred and twenty adult patients of American Society of Anaesthesiologists (ASA) physical status I and II of both genders, scheduled for surgical procedures under subarachnoid block and met the selection criteria, were randomized into four equal groups of 30 patients each, to receive either normal saline (Group NS), butorphanol 1 mg (Group B), granisetron 2 mg (Group G) or ketamine 50 mg (Group K) intravenously after institution of subarachnoid block. The incidence and grades of shivering were noted as a primary outcome. Secondary outcomes were changes in hemodynamics, sedation or any adverse effects of study drugs. Results- Post spinal shivering was observed in 42% patients of Group NS, 10% patients of Group B, 23% patient of Group G and 3% patients of Group K. The duration of sensory and motor block was prolonged in patients of Group B with statistically significant difference. Incidences of hypotension and bradycardia were comparable. All patients showed sedation score of 2 or 3 but respiratory depression was not observed in any patients. Conclusion- Intravenous ketamine 50 mg was more effective for prevention of post-spinal shivering with hemodynamic stability and sedation.

Keywords: Butorphanol, Granisetron, Ketamine, Spinal anesthesia, Shivering.