Role of Intrathecal Nalbuphine on Prevention of Post spinal Shivering After TURP: A Randomised Control Double Blind Study


Rajeev Kumar, Anshu Pangotra* and Vinod Verma

Background and Aim

Nalbuphine has been used intrathecally as an adjuvant in previous studies. The purpose of our study was to establish the effectiveness of intrathecal nalbuphine as an adjuvant to bupivacaine for prevention of shivering during spinal anesthesia in patients undergoing TURP.

Materials and Methods

In this prospective, randomized, double-blinded, controlled study, 200 ASA class I and II patients undergoing TURP under Subarachnoid Block (SAB), were randomly allocated to two groups: C and N. Group C received 0.5% hyperbaric bupivacaine 2.5 mlintrathecally. While group N received 2.5 ml of a mixture of 400 microgram nalbuphine plus hyperbaric bupivacaine (0.5%). Haemodynamic parameters along with core tympanic temperature were recorded preoperatively then every 10 minutes till the end of surgery. The incidence and severity of shivering was recorded during the surgery and in recovery room. Shivering was graded with a scale described by Bedside Shivering Assessment Score (BSAS). A score of 0 to 3 corresponds to mild, moderate or severe shivering.


The incidence of shivering was less in patients belonging to group N( 40) as compared to group C (5) (P>0.05).Incidence of PONV, respiratory depression, pruritis in group N was 4, 0 and 2 respectively as compared to group C it was 14, 2 and 7 respectively.


Nalbuphine used intrathecally is a useful adjuvant in SAB and, in a dose of 0.4 mg, it reduces the incident of shivering along with increasing postoperative analgesia.