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Background and Aims Post-spinal shivering is a common side effect of spinal anesthesia, particularly in elderly patients. This prospective randomized double-blind controlled study has the purpose to explore the effectiveness and safety of low dose intravenous clonidine, propofol and clonidine plus propofol for prophylaxis of shivering in elderly undergoing lower abdominal surgery under spinal anesthesia

Methods 80 patients (ASA I-III, age>65 years) scheduled for lower abdominal surgery under spinal anesthesia participated in the study. They were randomized to four groups, each of them with 20 patients, to receive 50µg clonidine (group C), 0,25 mg/kg propofol (group P), 50µg clonidine and 0,25 mg/kg propofol (group KP) and saline (group S). Drugs were administered after subarachnoid anesthesia with hyperbaric bupivacaine was performed. During surgery we recorded every 10’ the incidence of shivering and its severity using Bedside Shivering Assessment Scale as primary endpoints. Secondary endpoints included the incidence of sedation and nausea/vomiting and the evaluation of hemodynamics during surgery. Student’s t test was used for statistical interpretation considering p<0,05 as significant.

Results The incidence of shivering was significantly lower in groups CP (p<0,001), P (p<0,05), C(p<0,005) compared to placebo. Among the groups that received prophylactic medication, group CP showed an advantage documented by statistically relevant decrease of shivering incidence (p<0,01) compared to the other two groups . The incidence of sedation, the occurrence of nausea/vomiting and hemodynamic parameters registered similar values in all study groups.

Conclusions The combination of clonidine and propofol provide synergistic effects and is effective for controlling post-spinal anesthesia shivering in elderly .