Effects of Nalbuphine and Nefopam in the Management of Postoperative Shivering after Laparoscopic Cholecystectomy under General Anaesthesia: A Randomised Double-blind Study

Introduction: Postoperative shivering is a very common and unpleasant complication of laparoscopic surgery under General Anaesthesia (GA). Postoperative shivering is uncomfortable for the patient, and it might increase the postoperative complications especially in high-risk patients.

Aim: To compare the therapeutic effects of Nalbuphine and Nefopam in treating postoperative shivering in patients undergoing Laparoscopic Cholecystectomy (LC) under GA.

Materials and Methods: The present study was a randomised, double-blinded, study conducted at Government Medical College and Hospital, Kathua, Jammu and Kashmir, India, on 60 patients aged between 25 to 60 years, American Society of Anaesthesiologists (ASA) I and II scheduled for elective LC under GA, who had postoperative shivering during recovery period. Study duration was of one year (October 2021 to October 2022). Patients were randomly allocated into Group A (n=30, received nalbuphine) and Group B (n=30, received nefopam). Data was collected and compiled using Statistical Package for the Social Sciences (SPSS) 23.0 version. Student’s t-test and Chi-square test was used to analyse the data. The p-value <0.05 was considered as statistically significant.

Results: Time for cessation of shivering was 4.11±1.12 minutes in nalbuphine group as compared to 3.03±0.68 minutes in nefopam group which was statistically significant (p=0.001). Response rate was 73.33% in nalbuphine group as compared to 90% in nefopam group, and the difference was statistically significant (p=0.043). Similar incidence of bradycardia and vomiting was noted in both the groups. Nausea (6.67% vs 3.33%), pain on injection (3.33% vs nil) and pruritis (6.67% vs nil) were more in nalbuphine group as compared to nefopam group which was statistically significant. Sedation was more in nalbuphine group as compared to nefopam group (10% vs 6.67%) which was not significant statistically.

Conclusion: Nefopam as compared to nalbuphine had earlier cessation of shivering, better response rate and had less side-effects.