A prospective, randomized, double-blinded control study on comparison of tramadol, clonidine and dexmedetomidine for post spinal anesthesia shivering

Venkatraman, Rajagopalan; Karthik, Krishnamoorthy; Pushparani, Anand; Mahalakshmi, Annadurai

doi:10.1016/j.bjane.2016.08.001

Cited by 14 publications

(20 citation statements)

References 19 publications

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“…For instance, there was a randomized clinical trial conducted by Mathews et al (2002) that found tramadol to be superior to pethidine without any incidence of severe side-effects in preventing postanesthetic shivering (Mathews et al, 2002) another study reported the incidences of shivering in both tramadol groups were significantly lower than the groups that did not receive tramadol (Nakagawa et al, 2017). While a study conducted by Venkatraman et al (2018) found that dexmedetomidine is more effective than tramadol and clonidine in the treatment of shivering because of faster onset, lesser recurrence rate and better sedation (Venkatraman et al, 2018). Tramadol, m opioid receptor agonist which has the best combination of anti-shivering and analgesic efficacy without excessive sedation and significant side-effects.…”

Section: Resultsmentioning

confidence: 99%

The Effect of Tramadol on Decreasing Postoperative Shivering

Al-Dehayat¹,

Kamar²,

Kamar³

2020

Res. J. Med. Sci.

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Shivering is a well-recognized postoperative complication. The objective of the current study is to evaluate the role of tramadol in decreasing post anesthetic shivering. About 80 patients ASA I and II adult patients, aged between 18-70 years, undergoing general anesthesia were enrolled in this prospective study. They were divided into 2 groups, group 1 (n = 40) received 1 mg/kg of tramadol towards the end of the operation while group 2 (n = 40) received normal saline. Shivering was evaluated during the postoperative period. No difference among patients regarding patient characteristics. In group 1, postoperative shivering was effectively prevented in 36 (90%) and 38 (95%) patient at 15 and 30 min, respectively and none of patients shivered at grade = 3 and grade = 2. However, in group 2, the incidence of shivering was 50 and 57.5% at 15 min and 30, respectively, the difference between 2 groups was statistically significant (p<0.05). Tramadol, when given at the end of the operation can decrease the incidence of shivering.

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Section: Resultsmentioning

confidence: 99%

The Effect of Tramadol on Decreasing Postoperative Shivering

Al-Dehayat¹,

Kamar²,

Kamar³

2020

Res. J. Med. Sci.

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“…Figure 1 showed the flow chart of this meta-analysis. Thirteen studies were included, involving 864 patients (432 received dexmedetomidine and 432 tramadol) [9][10][11][12][13][14][15][16][17][18][19][20][21]. The characteristics of the identified clinical trials were displayed in Tables 1.…”

Section: Discussionmentioning

confidence: 99%

“…Surgeries were performed under spinal anesthesia in 12 studies [9][10][11][12][13][14][15][16][17][18][19][20] and under combined spinal and epidural anesthesia in one study [21]. In the included studies, 7 compared dexmedetomidine with tramadol [9][10][11][12][13][14][15] and the other 6 compared dexmedetomidine with tramadol and clonidine [16][17][18]20], pethidine [21] or butorphanol [19]. Because our study only compared dexmedetomidine with tramadol, clonidine, pethidine and butorphanol were neglected.…”

Section: Discussionmentioning

confidence: 99%

“…In this meta-analysis, dexmedetomidine has shorter time to cease shivering and a higher incidence of sedation than tramadol. But these outcomes have high heterogeneities, which are possibly associated with the following: 1) Inclusion criteria for shivering degree are different among the included studies, shivering degrees of 2 to 4 are included in 4 RCTs [14,16,18,19] and shivering degrees of 3 or 4 in the other 9 RCTs [9-13, 15, 17, 20, 21]. 2) The types and doses of local anesthetics for spinal anesthesia are different among the studies; 3) The types and duration of the surgeries are different.…”

Section: Discussionmentioning

confidence: 99%

“…There were 12 studies reporting the recurrent rate of shivering [9][10][11][12][13][14][15][16][17][18][19][20]. The value of I 2 = 0% indicated no heterogeneity.…”

Section: Recurrent Rate Of Shiveringmentioning

confidence: 99%

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Intravenous dexmedetomidine versus tramadol for treatment of shivering after spinal anesthesia: a meta-analysis of randomized controlled trials

Wang

Liu

2020

BMC Anesthesiol

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Background: Shivering is a frequent complication after spinal anesthesia. Increasing studies have compared the effect of intravenous dexmedetomidine and intravenous tramadol on shivering after spinal anesthesia, hence we performed a meta-analysis of randomized controlled trials to compare dexmedetomidine with tramadol on the treatment of post-spinal anesthesia shivering. Methods: PubMed, Embase, Cochrane library, Web of Science and Google Scholar were searched to find the eligible studies comparing the effect of dexmedetomidine and tramadol on the treatment of shivering after spinal anesthesia. Mean difference (MD) or risk ratio (RR) along with 95% confidence interval (CI) was used to analyze the outcomes. I 2 test was conducted to assess the heterogeneity of the included trials. We utilized Review Manager 5.3 to perform statistical analyses. Results: Thirteen randomized controlled trials including 864 subjects were included. Dexmedetomidine had higher effective rate of shivering control (RR =1.03; 95%CI [1.01, 1.06], P = 0.01, I 2 = 14%), shorter time to cease shivering (MD =-2.14; 95%CI [− 2.79, − 1.49], P < 0.00001, I 2 = 98%), lower recurrent rate of shivering (RR = 0.45; 95%CI [0.27, 0.73], P = 0.001, I 2 = 0%), lower incidences of nausea (RR = 0.10; 95%CI [0.05, 0.19], P < 0.00001, I 2 = 48%), and vomiting (RR = 0.13; 95%CI [0.06, 0.30], P < 0.00001, I 2 = 0%), higher incidence of sedation (RR = 2.48; 95%CI [1.32, 4.65], P = 0.005, I 2 = 82%), hypotension (RR = 2.50; 95%CI [1.24, 5.03], P = 0.01, I 2 = 0%) and bradycardia (RR = 4.78; 95%CI [1.76, 13.00], P = 0.002, I 2 = 0%), compared with tramadol. Conclusions: Dexmedetomidine is superior to tramadol for shivering treatment, due to higher effective rate of shivering control, earlier onset of action and lesser recurrence of shivering with higher incidence of sedation and lower incidences of nausea and vomiting. However, dexmedetomidine is also associated with higher incidences of hypotension and bradycardia than tramadol.

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Effect of intravenous tramadol versus pethidine on postspinal shivering control among mothers during cesarean section at Wolaita Sodo University Comprehensive Specialized Hospital, Southern Ethiopia: a prospective observational cohort study

Mamo

Zema

Abera

et al. 2023

Annals of Medicine &Amp; Surgery

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Background: Postspinal anesthesia shivering is a common complication during spinal anesthesia. It is very unpleasant and physiologically stressful for patients and challenging for healthcare providers. Shivering could be treated with tramadol or pethidine. However, the comparative effectiveness of one drug over the other drug has not been proven with a low-drug setup. Objective: To compare the effect of intravenous tramadol versus pethidine on postspinal shivering control among obstetric mothers who underwent cesarean section. Methods and materials: A prospective cohort study design was conducted on 180 ASA (American Society of Anesthesiology) I and II obstetric mothers. A systematic random sampling method was employed. Data were entered into EpiData version 4.6 and exported into SPSS version 25 for analysis. The independent sample t test was used to compare the difference of means between groups for normally distributed data, and the Mann–Whitney U test was used for non-normally distributed data. Categorical data were analyzed using the chi-squared test. Data were presented by mean±standard deviation for normally distributed data and median and interquartile range for non-normally distributed data. Categorical data were presented as numbers and frequencies. P values less than 0.05 were considered statistically significant. Results: One hundred eighty participants were used for analysis. The mean time of shivering disappearance was 5.5±1.75 min and 6.6±2.08 min in tramadol and pethidine groups, respectively (P<0.001). The hemodynamic changes were all comparable between the two groups. The difference in the recurrence of shivering after treatment was significant between the groups (P<0.001). Sedation was higher in the pethidine group, 9 (10%), than in the tramadol group, 2 (2.2%). Nausea and vomiting were found to be higher in the tramadol group, 10 (11.1%), than in the pethidine group, 5 (5.6%). Conclusions: Tramadol controlled shivering early, and recurrence of shivering and incidence of sedation were also low in the tramadol group. Therefore, tramadol is as effective as pethidine for the treatment of postspinal shivering in obstetric mothers who underwent cesarean delivery. So tramadol can be used as an alternative for postspinal shivering in obstetric mothers.

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A prospective, randomized, double-blinded control study on comparison of tramadol, clonidine and dexmedetomidine for post spinal anesthesia shivering

Cited by 14 publications

References 19 publications

The Effect of Tramadol on Decreasing Postoperative Shivering

The Effect of Tramadol on Decreasing Postoperative Shivering

Intravenous dexmedetomidine versus tramadol for treatment of shivering after spinal anesthesia: a meta-analysis of randomized controlled trials

Effect of intravenous tramadol versus pethidine on postspinal shivering control among mothers during cesarean section at Wolaita Sodo University Comprehensive Specialized Hospital, Southern Ethiopia: a prospective observational cohort study

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