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GENERAL ARTICLES

A Comparison of Urapidil, Clonidine, Meperidine and Placebo in Preventing Postanesthetic Shivering

Department of Anesthesiology and Critical Care, Hospital of the City Ludwigshafen, Ludwigshafen, Germany

Address correspondence and reprint requests to Dr. Swen N. Piper, Department of Anesthesiology and Intensive Care, Hospital of the City Ludwigshafen, Bremserstr. 79, D-67063 Ludwigshafen, Germany.

This placebo-controlled study was performed to evaluate the efficacy of urapidil compared with clonidine and meperidine in preventing postanesthetic shivering, which is common after anesthesia administration and may be very distressing. We studied 120 patients undergoing elective abdominal or orthopedic surgery under standardized general anesthesia. After surgery, patients were randomly assigned to one of four groups (each group n = 30) using a double-blinded protocol: Group A received 0.2 mg/kg urapidil; Group B, 3 µg/kg clonidine; Group C, 0.4 mg/kg meperidine; and Group D, saline 0.9% as placebo. Postanesthetic shivering was scored by using a five-point scale. Clonidine and meperidine significantly reduced the incidence and the severity of shivering in comparison with placebo, whereas there were no significant differences between the urapidil and placebo groups. Both clonidine and meperidine caused a significantly prolonged emergence time (13.4 ± 5.8 and 13.3 ± 5.0 min, respectively) compared with placebo (10.4 ± 5.3 min) and urapidil (11.4 ± 2.9 min). We confirmed that both clonidine and meperidine are effective in preventing postanesthetic shivering, whereas urapidil, in our setting and dosage, was not effective. Patients who received clonidine or meperidine had a prolonged emergence time. In the dosage used, urapidil seems to be unable to prevent postanesthetic shivering.

Implications: Shivering (irregular muscle activity) is common after surgery and anesthesia. This study compared urapidil (an antihypertensive drug) as a prophylaxis with two established antishivering drugs (meperidine and clonidine) and placebo. In the dosage used, we were unable to show a significant benefit of urapidil.

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