COMPARISON OF INTERVENTIONAL USE OF TRAMADOL AND PETHIDINE FOR THE MANAGEMENT OF SHIVERING DURING SPINAL ANAESTHESIA

Abstract

Back ground:

Shivering occurring under spinal anaesthesia is uncomfortable for patients and places the body under physiologic stress. It can increase oxygen consumption, metabolic rate and cause artifacts on the monitor. The incidence of shivering has been found to be quite high, approximating 40-60% in different studies. In lower limb orthopaedic surgery, regional anaesthesia provides useful benefits such as reduced incidence of peri-operative deep vein thrombosis and better postoperative pain relief compared with general anaesthesia. The deleterious effect of shivering warrant a prompt and rapid control on occurrence.

Aim and Objective:      

This study compared the effectiveness of intravenous 0.35 mg kg^-1 pethidine and  intravenous  0.25 mg kg^-1 tramadol in abolishing shivering in patients undergoing spinal anaesthesia for lower limb orthopaedic surgery.

Patients and Methods:

This was a  prospective,  randomised, double-blinded study conducted in 100 ASA grade I and II eligible patients aged between 15 and 65 years of age who were scheduled for lower limb orthopaedic surgery and  shivered during spinal anaesthesia.

All the patients had preloading with warmed normal saline administered at a dose of 10 ml kg^-1 . Spinal anaesthesia was induced in the sitting position with 3 mls of 0.5% hyperbaric bupivacaine before being positioned for surgery. When shivering occurred, the patients were given either intravenous 0.35 mg kg^-1 pethidine or intravenous  0.25 mg kg^-1tramadol based on the group allocation; taking notice of a change in the intensity or dissappearance of shivering as well as haemodynamic parameters such as non-invasive blood pressure, pulse rate, peripheral oxygen saturation and temperature at intervals. Also noted were time to disappearing and recurrence of shivering as well as outcomes such as level of sedation, nausea and vomiting.

Results:

A total of 100 patients met the inclusion criteria and participated in the study out of 394 consecutive patients. The incidence of shivering was 25.38%. Complete disappearance of shivering occurred in 41(82%) patients in the tramadol group compared to 34(68%) in the pethidine group (p=0.0059). Recurrence of shivering after treatment was seen in 10(20%) patients in tramadol group compared to 6(12%) in the pethidine group (p=0.555). The most common side effect noted was nausea occurring in 16(32%) patients in the tramadol group compared to 26(52%) of the pethidine group (p=0.149). A total of 17(34%) patients in the tramadol group had sedation compared to 6(12%) in the pethidine group (p=0.285).

There were no significant differences in the mean arterial pressures, heart rate and axillary temperature of the two groups.

Conclusion:

The result of this study revealed that  intravenous 0.25 mg kg^-1 tramadol use for abolishing spinal anaesthesia induced shivering is as effective as intravenous 0.35 mg kg^-1  pethidine in lower limb orthopaedic surgery, however it’s use is associated with more sedation.