Comparative study of dexmedetomidine, butorphanol and tramadol for post-spinal anesthesia shivering

Neuraxial anesthesia impairs thermoregulation causing shivering. This study evaluated effects of dexmedetomidine, butorphanol and tramadol on post spinal anesthesia shivering and also observed side-effects to find effective, faster and safer agent to control shivering after neuraxial blockade. Randomized, prospective study was conducted in 96 patients (divided into 3 groups) who developed shivering under spinal anesthesia. Patients received either intravenous, 0.5 mg/kg tramadol, 0.01mg/kg butorphanol, or 0.5μg/kg dexmedetomidine. Control of shivering, time taken for cessation, recurrence, hemodynamic changes, and side effects were compared. No significant difference in demographic profile. At onset of shivering, hemodynamic variables were comparable in all 3 groups. After treatment, significant bradycardia noted in dexmedetomidine group (P < 0.092).Cessation of shivering at 5^th min was 100%, 50%, and 96.87% for Groups D, T, and B respectively. Time taken was significantly lower (3.12 � 0.9) in Group D than Group T (5.03 � 1.15) and B (4.09 � 1.57) mins. Recurrence was also significantly less in dexmedetomidine (0%) group compared with butorphanol (18.75%) and tramadol (9%). 40% cases in Group T had nausea and vomiting (p < 0.000). Higher incidence of grade 3 sedation was observed in dexmedetomidine (68.8%) and butorphanol (46.875) groups compared with Tramadol (4%). Episodes of oxygen desaturation was not significant (P > 0.5). Although all three drugs are effective, Dexmedetomidine seems superior due to higher rates of success, earlier onset of action, lesser recurrence and removes anxiety with minimal adverse effects, as compared to butorphanol which showed higher recurrence rate and tramadol which had higher incidence of side effects and delayed onset of action.