Dexmedetomidine versus Nalbuphine for treatment of postspinal shivering in patients undergoing vaginal hysterectomy: A randomized, double blind, controlled study

Objectives
Shivering is very distressing for the patient therefore, control of postspinal shivering is essential for proper perioperative care. This study was designed to compare the efficacy, safety and cost effectiveness of Dexmedetomidine and Nalbuphine in the treatment of postspinal shivering.
Methods
In this prospective, randomized, double-blind, placebo controlled study, 75 American Society of Anesthesiologists Grade I and II females scheduled for vaginal hysterectomy under spinal anesthesia, who developed shivering grade 3 or 4 were included. The patients were randomized into three groups of 25 patients each to receive either Nalbuphine 0.07 mg/kg (group N) or Dexmedetomidine 0.5 μg/kg (group D) or saline (group C) as a slow intravenous bolus for treatment of shivering. Onset of shivering, grade of shivering, time for cessation, response rate, recurrence, hemodynamic parameters and adverse effects were observed at scheduled intervals.
Results
It was observed that the mean response time for control of shivering was significantly less in Group D (1.97 ± 0.61 min) compared to Group N (3.56 ± 0.82 min) and Group C (12.4 ± 3.74 min). Success rate in Group D was 100% compared to 92% in Group N and 32% in Group C. Relapse of shivering was observed more in patients of Group N (8.7%) as compared to Group D (0%) while shivering reappeared in 75% of patients who responded to saline treatment. Among the side effects, sedation was found in both groups N and D. Bradycardia and hypotension were more frequent in Dexmedetomidine group although none of the patients required treatment. Pain during injection was an outstanding complaint in Nalbuphine group.
Conclusion
Both Nalbuphine and Dexmedetomidine control shivering effectively, but Dexmedetomidine seems to be a better choice than Nalbuphine for treatment of postspinal shivering due to its shorter response time, lower recurrence rate and associated sedation. Meanwhile, Nalbuphine offers more hemodynamic stability and lower costs.