Comparison of Intravenous Tramadol 0.25 mg/kg and 0.5 mg/kg for Prevention of Shivering in Patients Undergoing Spinal Anesthesia
Article Sidebar
Main Article Content
Abstract
Background: Tramadol 0.5 mg/kg is the least effective dose for the prevention of shivering. No studies have been done on the dose of tramadol 0.25 mg/kg to prevent shivering. This study aims to compare the efficacy of intravenous tramadol 0.25 and 0.5 mg/kg for the prevention of shivering in patients who undergoing spinal anesthesia. Methods: A prospective, randomized, double-blind study was conducted. 86 patients who were scheduled for elective surgery under spinal anesthesia were randomly assigned to receive tramadol 0.25 mg/kg (group 1) and tramadol 0.5 mg/kg (group 2). After the patients received intrathecal injection of heavy bupivacaine anesthesia, their body temperature, blood pressure, and shivering level were measured using Crossley and Mahajan scale (The Shivering Classification). Results: The effectiveness in preventing shivering of group 1 and 2 were 81.4% and 86.0% (P= 0.559), with 18.6% of grade 3 or higher of shivering in group 1 and 14.0% in group 2 (P=0.502). The side effects in both groups were not different. Conclusion: The prevention of post-anesthetic shivering by use of 0.25 mg/kg and 0.5 mg/kg of tramadol has no different results and the side effects of the two groups of drugs were not different.
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
References
Ozaki M, Kurz A, Sessler DI, et al. Thermoregulatory thresholds during epidural and spinal anesthesia. Anesthesiology. 1994;81:282-8.
Jeon YT, Jeon YS, Kim YC, Bahk JH, Do SH, Lim YJ. Intrathecal clonidine does not reduce post-spinal shivering. Acta Anaesthesiol Scand. 2005;49:1509-13.
Chow TC, Cho PH. The influence of small dose intrathecal fentanyl on shivering during transurethral resection of prostate under spinal anesthesia. Acta Anaesthesiol Sin. 1994;32:165-70.
Imrie MM, Hall GM. Body temperature and anaesthesia. Br J Anaesth. 1990;64:346-54.
Girma T, Alemu W, Assen S. Effect of prophylactic intrathecal pethidine on the incidence of shivering on mothers undergoing cesarean section under spinal anesthesia: a randomized controlled trial. Front Med. 2022;9:887724.
de Witte J, Deloof T, de Veylder J, Housmans PR. Tramadol in the treatment of postanesthetic shivering. Acta Anaesthesiol Scand. 1997;41:506-10.
Driessen B, Reimann W. Interaction of the central analgesic, tramadol, with the uptake and release of 5-hydroxytryptamine in the rat brain in vitro. Br J Pharmacol. 1992;105:147-51.
Driessen B, Reimann W, Giertz H. Effects of the central analgesic tramadol on the uptake and release of noradrenaline and dopamine in vitro. Br J Pharmacol. 1993;108:806-11.
Crossley AW, Mahajan RP. The intensity of postoperative shivering is unrelated to axillary temperature. Anaesthesia. 1994;49:205-7.
Mohta M, Kumari N, Tyagi A, Sethi AK, Agarwal D, Singh M. Tramadol for prevention of postanaesthetic shivering: a randomised double-blind comparison with pethidine. Anaesthesia. 2009;64:141-6.
Nazir A, Dar FA, Javed T. A comparative study; Prophylactic intravenous ketamine and tramadol in preventing intraoperative shivering in patients undergoing elective lower limb surgery under spinal anaesthesia. Am J Adv Drug Deliv. 2015;3:011-7.
Javaherforoosh F, Akhondzadeh R, Aein KB, Olapour A, Samimi M. Effects of tramadol on shivering post spinal anesthesia in elective cesarean section. Pak J Med Sci. 2009;25:12-7.
Onyekwulu FA, Agu EE, Amucheazi AO. Efficacy of intravenous tramadol in the control of shivering following spinal anaesthesia for caesarean section. Niger Postgrad Med J. 2016;23:116-20.
Wason R, Jain N, Gupta P, Gogia AR. Randomized double-blind comparison of prophylactic ketamine, clonidine and tramadol for the control of shivering under neuraxial anaesthesia. Indian J Anaesth. 2012;56:370-5.
Ularangkura W, Chokchalermwong N, Sukonpatip T. Efficacy of intravenous paracetamol for prevention of shivering in cesarean section under spinal anesthesia: a randomized controlled trial. Thai J Anesthesiol. 2023;49:311-8.
Lema GF, Gebremedhn EG, Gebregzi AH, Desta YT, Kassa AA. Efficacy of intravenous tramadol and low-dose ketamine in the prevention of post-spinal anesthesia shivering following cesarean section: a double-blinded, randomized control trial. Int J Women’s Health. 2017;9:681-8.
Lakhe G, Adhikari KM, Khatri K, Maharjan A, Bajracharya A, Khanal H. Prevention of shivering during spinal anesthesia: comparison between tramadol, ketamine and ondansetron. JNMA J Nepal Med Assoc. 2017;56:395-400.
Cahyadi R, Nasution AH, Lubis A. Comparison of intravenous ketamine 0.25 mg/kgBW and intravenous tramadol 0.5 mg/kgBW for prevention of shivering post spinal anesthesia. Int J Innov Sci Res Technol. 2019;4:262-70.
Seyam SH. Prevention of post-spinal anesthesia shivering: low dose ketamine vs tramadol. Al-Azhar Int Med J. 2020;1:108-15.
ธิดารัตน์ อริยานุชิตกุล, ศักดิ์กฤษณ์ ประสิทธิ์ศุภการ. ปัจจัยที่มีผลต่อการเกิดอาการหนาวสั่นระหว่างผ่าตัดในผู้ป่วยผ่าตัดกระดูกที่ได้รับการฉีดยาชาเข้าช่องไขสันหลัง. วิสัญญีสาร. 2563;46:234-9.
Ameta N, Jacob M, Hasnain S, Ramesh G. Comparison of prophylactic use of ketamine, tramadol, and dexmedetomidine for prevention of shivering after spinal anesthesia. J Anaesthesiol Clin Pharmacol. 2018;34:352-6.
Gangopadhyay S, Gupta K, Acharjee S, Nayak S K, Dawn S, Piplai G. Ketamine, tramadol and pethidine in prophylaxis of shivering during spinal anaesthesia. J Anaesthesiol Clin Pharmacol. 2010;26:59-63.