A Randomized Double-Blinded Study of Dexmedetomidine and Clonidine for Control of Post-Spinal Shivering in Patients Undergoing Elective Surgeries

Abstract

Background

Post-spinal shivering is a frequent complication following neuraxial anesthesia, with reported incidence ranging from 20–70%. It increases oxygen consumption, carbon dioxide production, catecholamine release, and may precipitate adverse cardiovascular outcomes. α2-adrenergic agonists such as dexmedetomidine and clonidine have demonstrated anti-shivering properties by modulating thermoregulatory thresholds and central sympathetic outflow. However, comparative evidence between these two agents in post-spinal shivering remains limited.

Aim

To compare the efficacy of intravenous dexmedetomidine and clonidine in controlling post-spinal shivering.

Methods

This prospective, randomized, double-blinded study included 60 ASA I–II patients (20–60 years) who developed Grade 2–3 shivering following spinal anesthesia. Patients were allocated into two groups:

• Group D: Dexmedetomidine 0.5 µg/kg IV over 10 minutes


• Group C: Clonidine 1 µg/kg IV over 10 minutes

Primary outcome was time to cessation of shivering. Secondary outcomes included recurrence rate, sedation (Filos scale), hemodynamic changes, and adverse effects.

Results

Dexmedetomidine demonstrated significantly faster control of shivering compared with clonidine (p < 0.001). Recurrence was lower in the dexmedetomidine group. Both groups maintained acceptable hemodynamic stability, although clonidine showed a higher incidence of bradycardia. Sedation was adequate and comparable between groups without clinically significant respiratory depression.

Conclusion

Dexmedetomidine provides faster and more sustained control of post-spinal shivering compared to clonidine, with an acceptable safety profile. It may be considered the preferred α2-agonist for management of post-spinal shivering.