IOSR Journal of Dental and Medical Sciences (IOSR-JDMS)
e-ISSN: 2279-0853, p-ISSN: 2279-0861.Volume 20, Issue 8 Ser.2 (August. 2021), PP 55-58
www.iosrjournals.org
To Assess the Effectiveness of Low-dose Granisetron on Shivering
inepidural block: A prospective randomized controlled study
Dr Deepak Choudhary1, Dr Sandeep Kumar2* Dr Satyapal Dhaka3
1,2,3
Department of Anaesthesiology, DBH, Churu, India
*
Corresponding Author: Dr Sandeep Kumar
Department of Anaesthesiology, DBH, Churu, India
Abstract
Shivering after central neuraxial blockade is unpleasant not only for patients but for anaesthesiologists as well
as it induces hypoxemia, lactic acidosis, increased intraocular pressure and intracranial pressure, increased
chances of myocardial ischemia and interference with patient’s monitoring. Serotonin antagonists reduces the
incidence of shivering in patients with spinal anesthesia. Granisetron is better than ondansetron with longer
half life and fewer side effects. After getting approval from the ethical committee 60 patients aged between 20-
60 years of ASA group I &II were studied over a period of 2 months. Patients of test group G were given
granisetron 10μg/kg body weight intravenously before anaesthesia whereas group C was control group. The
administration of low dose granisetron reduced the incidence of shivering as well as the degree of intensity of
shivering post epidural anaesthesia.
Keywords: Shivering, Granisetron, Epidural block.
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Date of Submission: 26-07-2021 Date of Acceptance: 11-08-2021
---------------------------------------------------------------------------------------------------------------------------------------
I. Introduction
Shivering is unpleasant and causes several undesirable physiologic consequences such as increase in
oxygen consumption, carbon dioxide production, chances of myocardial ischemia, infection, bleeding, and
minute ventilation. It also induces hypoxemia and lactic acidosis, increased intraocular pressure and intracranial
pressure, and interferes with patient monitoring such as ECG, noninvasive blood pressure, and oxygen
saturation (SaO2). In regional anesthesia spinal anaesthesia is known to decrease the shivering threshold,
preceded by core hypothermia and vasoconstriction above the level of block[1]. But no study assessing the
effect of granisetronfollowing epidural block is being studied.
Regional anaesthesia may impair thermoregulatory control, and up to a 57% incidence of shivering
during regional anaesthesia has been reported. Shivering during neuraxial anesthesia could have potentially
detrimental effects. Regional anesthesia produces vasodilatation, which facilitates core-to-peripheral
redistribution of heat[2].
Shivering increases intraocular or intracranial pressure. It also increases the metabolic rate by 100%–
130%[3]. Shivering is dangerous for patients who suffer from cardiopulmonary diseases[4]. Anesthetic agents
such as clonidine, magnesium sulfate, ketamine, tramadol, ondansetron, and dexamethasone are often used as a
premedication. However, these drugs have not significantly reduced the incidence of shivering[5]. Serotonin
antagonists potentially reduces the incidence of shivering in patients with spinal anesthesia. Granisetron and
ondansetron are classified as serotonin antagonist drugs. Ondansetron commonly used as a premedication in
regional and general anesthesia[6]. Granisetron prevents postoperative nausea and vomiting (PONV) in post
chemotherapy. The previous study showed that granisetron is better than ondansetron because it has a longer
half-life and has fewer side effects[7]. The aim of the study is to determine the effect of low-dose granisetron on
shivering incidence in post epidural anesthesia
II. Materials and Methods
For this prospective, randomized, controlled, parallel-group study, patients of both sexes, aged between
20 and 60 years, with an ASA physical status of I–II, with Glasgow coma scale 15, were included if they were
scheduled to undergo lower half surgeries under epidural anesthesia such as lower limb orthopedic surgeries,
lower limbplastic surgeries, or lower abdominal surgeries. Patients were excluded if have any of the following
exclusion criteria: 1. Who refused toparticipate. 2. Had any contraindications to epidural block. 3. Had a history
of hypersensitivity to studied drugs. After approval of the departmental research committee, this study was
conducted from Over a Period of 12 months at DBH, Churu, India on 60 patients undergoing lower half
surgeries after signing a written informed consent. Patients who experienced granisetron side effects, massive
DOI: 10.9790/0853-2008025558 www.iosrjournal.org 55 | Page
e-ISSN: 2279-0853, p-ISSN: 2279-0861.Volume 20, Issue 8 Ser.2 (August. 2021), PP 55-58
www.iosrjournals.org
To Assess the Effectiveness of Low-dose Granisetron on Shivering
inepidural block: A prospective randomized controlled study
Dr Deepak Choudhary1, Dr Sandeep Kumar2* Dr Satyapal Dhaka3
1,2,3
Department of Anaesthesiology, DBH, Churu, India
*
Corresponding Author: Dr Sandeep Kumar
Department of Anaesthesiology, DBH, Churu, India
Abstract
Shivering after central neuraxial blockade is unpleasant not only for patients but for anaesthesiologists as well
as it induces hypoxemia, lactic acidosis, increased intraocular pressure and intracranial pressure, increased
chances of myocardial ischemia and interference with patient’s monitoring. Serotonin antagonists reduces the
incidence of shivering in patients with spinal anesthesia. Granisetron is better than ondansetron with longer
half life and fewer side effects. After getting approval from the ethical committee 60 patients aged between 20-
60 years of ASA group I &II were studied over a period of 2 months. Patients of test group G were given
granisetron 10μg/kg body weight intravenously before anaesthesia whereas group C was control group. The
administration of low dose granisetron reduced the incidence of shivering as well as the degree of intensity of
shivering post epidural anaesthesia.
Keywords: Shivering, Granisetron, Epidural block.
---------------------------------------------------------------------------------------------------------------------------------------
Date of Submission: 26-07-2021 Date of Acceptance: 11-08-2021
---------------------------------------------------------------------------------------------------------------------------------------
I. Introduction
Shivering is unpleasant and causes several undesirable physiologic consequences such as increase in
oxygen consumption, carbon dioxide production, chances of myocardial ischemia, infection, bleeding, and
minute ventilation. It also induces hypoxemia and lactic acidosis, increased intraocular pressure and intracranial
pressure, and interferes with patient monitoring such as ECG, noninvasive blood pressure, and oxygen
saturation (SaO2). In regional anesthesia spinal anaesthesia is known to decrease the shivering threshold,
preceded by core hypothermia and vasoconstriction above the level of block[1]. But no study assessing the
effect of granisetronfollowing epidural block is being studied.
Regional anaesthesia may impair thermoregulatory control, and up to a 57% incidence of shivering
during regional anaesthesia has been reported. Shivering during neuraxial anesthesia could have potentially
detrimental effects. Regional anesthesia produces vasodilatation, which facilitates core-to-peripheral
redistribution of heat[2].
Shivering increases intraocular or intracranial pressure. It also increases the metabolic rate by 100%–
130%[3]. Shivering is dangerous for patients who suffer from cardiopulmonary diseases[4]. Anesthetic agents
such as clonidine, magnesium sulfate, ketamine, tramadol, ondansetron, and dexamethasone are often used as a
premedication. However, these drugs have not significantly reduced the incidence of shivering[5]. Serotonin
antagonists potentially reduces the incidence of shivering in patients with spinal anesthesia. Granisetron and
ondansetron are classified as serotonin antagonist drugs. Ondansetron commonly used as a premedication in
regional and general anesthesia[6]. Granisetron prevents postoperative nausea and vomiting (PONV) in post
chemotherapy. The previous study showed that granisetron is better than ondansetron because it has a longer
half-life and has fewer side effects[7]. The aim of the study is to determine the effect of low-dose granisetron on
shivering incidence in post epidural anesthesia
II. Materials and Methods
For this prospective, randomized, controlled, parallel-group study, patients of both sexes, aged between
20 and 60 years, with an ASA physical status of I–II, with Glasgow coma scale 15, were included if they were
scheduled to undergo lower half surgeries under epidural anesthesia such as lower limb orthopedic surgeries,
lower limbplastic surgeries, or lower abdominal surgeries. Patients were excluded if have any of the following
exclusion criteria: 1. Who refused toparticipate. 2. Had any contraindications to epidural block. 3. Had a history
of hypersensitivity to studied drugs. After approval of the departmental research committee, this study was
conducted from Over a Period of 12 months at DBH, Churu, India on 60 patients undergoing lower half
surgeries after signing a written informed consent. Patients who experienced granisetron side effects, massive
DOI: 10.9790/0853-2008025558 www.iosrjournal.org 55 | Page
