A comparative Study Between Pethidine, Granisetron and Tramadol in Prophylaxis Against Perioperative Shivering After Spinal Anesthesia

Abstract

Background: Peri-operative shivering, a challenging discomfort faced in anesthesiologists' daily practice. Many drugs were used as a prophylaxis, but there was no consensus on ideal or standard drug yet. Aim of the work: To compare the effectiveness and safety of pethidine, granisetron and tramadol in prophylaxis against perioperative shivering after spinal anesthesia. Patients and methods: Sixty adult patients, who underwent spinal anesthesia, were included. They were randomly assigned to granisetron, pethidine or tramadol (20 in each group), and submitted to standard intraoperative monitoring and follow up for postoperative 4 hours. Monitoring included electrocardiography, oxygen saturation, respiratory rate, temperature, non-invasive blood level, conscious level and sedation score. Side effects were documented. Results: Intra-and post-operatively, there was significant reduction of heart rate in granisetron and tramadol groups. Mean arterial pressure significantly decreased in granisetron group at the time from 30 minutes to the end of surgery and during the first two postoperative hours. Respiratory rate significantly decreased in pethidine group during the complete intra-and post-operative period. Granisetron had no sedative effect at all, but sedation was significantly increased among pethidine group. Finally, perioperative shivering was reported in 25%, 15% and 15% of pethidine, granisetron and tramadol groups respectively. Nausea/vomiting was reported in 20%, 10.0%, and 0% of pethidine, tramadol and granisetron groups respectively. Pruritus was confined to 30% pethidine group with significant difference. Conclusion: Granisetron, tramadol and pethidine, all are effective as a prophylaxis against perioperative shivering after spinal anesthesia. However, granisetron seems to be the most suitable drug.

Comparison of granisetron 10 µg/kg vs 40 µg/kg intravenous for prophylaxis of shivering after spinal anesthesia for lower abdominal surgery

“…5,7 Post-anesthesia shivering is a very unpleasant experience and psychologically stressful to the patient, causing several undesirable physiological consequences such as increased blood pressure, tachycardia, and increased intraocular and intracranial pressure. 1,5,7,8 Shivering can also increase aerobic metabolism which in turn causes an increase in tissue oxygen demand as much as 150%, 10 increases the synthesis of carbon dioxide and lactic acidosis which causes an increase in pulmonary ventilation capacity and cardiac workload. 14,9,10 It also increases metabolic rate up to 400%, and can cause myocardial ischemia, which is very dangerous for patients with cardiopulmonary disorders, 1,5,[11][12][13] and interferes with the patient monitoring by causing artifacts on electrocardiographic trace, blood pressure and pulse oximetry.…”

Successful Management of a Suspected Case of Meperidine-Induced Anaphylaxis in Cesarean Delivery

“…This life-threatening condition may happen unpredictable, and consequently, the anesthesiologist maybe not be prepared for it. Meperidine is a synthetic opioid of the phenylpiperidine class that acts through µ and kappa receptors (3). It has been successfully used with no significant adverse effects during CS in both general and regional anesthesia (4,5).…”