Comparison between the effect of nefopam, ondansteron or meperidine in preventing post anesthetic shivering

ABSTRACT

This study was carried on 80 adult patients undergoing elective surgery of more than 60min duration to compare the efficacy of nefopam, ondansetron or meperidine in preventing post-anesthetic shivering. All patients were allocated blindly into 4 groups according to drugs given. 0.15 mg/kg nefopam hydrochloride, 4 mg ondansetron, 0.4 mg/kg meperidine and10 ml saline were given intravenous before endotracheal extubation in G I, II, HI and IV respectively The results of the study showed that; core esophageal temperature [COT] and finger tip temperature [FTT] decreased significantly in all groups during intra- and postoperative times compared to preoperative values. Both readings did not significantly change at postoperative times when four groups compared to each other. Post anesthetic shivering was assessed by Wrench scale [0-4]. The highest incidence of shivering was manifested ingroup IV versus groups I, II and III up to 4 h postoperative. The least incidence of shivering was manifested in group III versus groups I, II and IV at 5 and 15 min postoperative. Arterial oxygen content and venous oxygen content decreased significantly in group IV compared to groups I, II and III at all times of measurements postoperative. Meanwhile both readings increased significantly in group III compared to groups I, II and IV at Sand 15 minutes postoperative and they were still the highest values in group III compared to groups I and IV at 60 minutes postoperative. Oxygen extraction ratio [O2 ER] and blood lactate level [BLL] increased significantly in group IV compared to groups I, II and III at 5, 15 and 60 minutes postoperative and O2 ER decreased significantly in group III compared to groups I, II and IV at 15 and 60 minutes postoperative. Post operative pain score was assessed using VAS. The highest incidence of pain was manifested in groups II and IV versus groups I and III and the least incidence of pain was manifested in group Ill versus groups II and IV up to 6 hours post operative. At 24 hours postoperative the highest incidence of pain was manifested in group IV versus groups I, II and III. In conclusion nefopam, ondansetron and meperidine reduced the incidence of PAS with varying degrees. Meperidine was more effective in controlling PAS, and maintaining tissue oxygenation than nefopam, and ondansetron. This study recommended, the prophylactic use of meperidine at the end of surgery to decrease incidence of PAS, further studies to evaluate the minimal effective dose of nefopam and ondansetron in preventing PAS and to evaluate the combination of pharmacological and nonpharmacological methods for prevention of PAS