Hyperbaric Bupivacaine alone Versus Hyperbaric Bupivacaine and Tramadol Combination for Shivering in Spinal Anaesthesia Surgeries
Muhammad Fareed Azam, Sara Mahsud, Gulwish Salahuddin, Rukhsana Shaheen Afzal, Abdul Hameed, Mahwash Azam Khan
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ABSTRACT
Background: Shivering is a normal physiologic
protective mechanism of the body, which in response to core hypothermia,
increases metabolic heat production that results in involuntary, oscillatory
muscle activity. Spinal anesthesia promotes
redistribution of body heat from central to the peripheral compartments. After
spinal anesthesia shivering occurs in 40-60% of patients. Tramadol is synthetic
codeine analog that is weak Mu opioid receptor agonist. It also has effect of
norepinephrine and serotonin reuptake inhibition. It proves to be more
effective in prevention and treatment of shivering and it also has less side
effects then Mu opioid agonists.
Objective: To compare the outcome
of hyperbaric bupivacaine alone, with combination of hyperbaric bupivacaine and
tramadol to prevent frequency of shivering in spinal anaesthesia.
Study Design: Randomized clinical
trial study.
Place and Duration of Study: Department
of Anaesthesiology & Gynaecology, POF Hospital, Wah Cantt, HIT Taxilla and
Izzat Ali Shah Hospital, Wah Cantt from 1st December 2018 to 31st
December 2020.
Methodology: One hundred and 100
patients were included and divided into two equal groups. Patients in Group A
received 2ml of 0.75% hyperbaric bupivacaine (15mg) and group B received 2ml of
0.75% hyperbaric bupivacaine (15mg) and preservative free tramadol (10mg,
0.2ml) in spinal anesthesia.
Results: There were 13 (26%)
female patients in group A and 37 (74%) male patients. In group B there were 35
(70%) male patients and 15 (30%) female patients. The mean age in group A was
42±8.05 years and 42±8.02 years in group B. Thirty two (64%) in whom shivering
was present and 18 (36%) no shivering accrued in group A while in group B, 11
(22%) in whom shivering was present and 39 (78%) no shivering accrued
(P<0.05).
Conclusion: Post-anesthetic
shivering appeared to be present in post spinal anaesthesia patients very
commonly. Administration of tramadol has proved to significantly reduce
incidence of shivering. More studies still need to be done on tramadol to
confirm its efficacy in preveting and stopping shivering without systemic
effects on patients.
Keywords: Spinal anaesthesia,
Bupivacaine, Tramadol, Shivering