Comparison of Pethidine and Tramadol for Control of Shivering in Patients undergoing Elective Surgery under Spinal Anesthesia

Abstract

Introduction: Shivering is a common problem faced by an anesthesiologist during intraoperative as well as in postoperative period, specially after sub-arachnoid block (SAB). It is unpleasant and undesirable and is secondary to vasodilation following sympathetic blockade. The present study was designed to evaluate the efficacy of pethidine on postoperative shivering following SAB and to compare its effects with those of tramadol.
 
 Methods: This randomized, prospective study was conducted in American society of anesthesiologists (ASA) grade I and II patients undergoing surgery under SAB, to compare the efficacy of tramadol and pethidine for control of shivering. Patients received tramadol or pethidine in a dose of 0.5mg/kg intra-venously after the appearance of shivering. Disappearance of shivering, side-effects as well as hemodynamics were observed at scheduled intervals.
 
 Results: There were a total of 79 patients randomized into two groups. There were 44 patients receiving pethidine (Group P) and the rest 35 receiving tramadol (Group T). Shivering score was significantly lower in Group P at 10, 15, 20, and 30 minutes compared to that in Group T. Sedation score was higher in pethidine group. Adverse effects in terms of nausea and vomiting was significantly higher in Group T.
 
 Conclusion: Pethidine provide better anti-shivering effect then tramadol with less side effects (nausea and vomiting) but more sedation.

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

“…They also revealed the shivering recurrence rate to be low in tramadol and more nausea vomiting in pethidine group. On the other side, Sharma et al [20] found pethidine to be more effective than tramadol in prophylaxis of shivering at 10, 15, 20 and 30 min while there was no significant difference at 5 and 25 min after giving study drugs. Pethidine was associated with more sedation (as in the present work for this point) and tramadol caused significant nausea and vomiting.…”

Effects of oral premedication with tramadol, pregabalin or clonidine on shivering after spinal anaesthesia in patients undergoing hysteroscopic procedures

“…Its anti-shivering effects may also be partially explained by its effects at the level of the pons. Thus, it has emerged as a more effective and safer alternative for prevention and management of post-anaesthetic shivering [ 23 , 24 ]. Our trial showed that oral tramadol was effective in reducing the incidence, frequency, duration and severity of post-spinal shivering and meperidine consumption.…”

Prophylaxis of Post Spinal Shivering: A Comparative Study between Intravenous Ondansetron and Meperidine

“…6 Meperidine has the longest standing history as a medical treatment for PAS and there is substantial amount of evidence supporting its use as an anti-shivering agent. 9 However, Meperidine has undesirable side effects like nausea, vomiting, pruritus, respiratory depression etc. 9 Recently Ondansetron has been tried to prevent PAS.Ondansetron, a 5 HT3 antagonist, is widely used to prevent postoperative & pregnancy induced nausea and vomiting.…”

“…9 However, Meperidine has undesirable side effects like nausea, vomiting, pruritus, respiratory depression etc. 9 Recently Ondansetron has been tried to prevent PAS.Ondansetron, a 5 HT3 antagonist, is widely used to prevent postoperative & pregnancy induced nausea and vomiting. 8 The antishivering effect of Ondansetron may be related to central mechanism by inhibiting 5HT (Serotonin) reuptake in the preoptic anterior hypothalamic region.…”

“…8 The antishivering effect of Ondansetron may be related to central mechanism by inhibiting 5HT (Serotonin) reuptake in the preoptic anterior hypothalamic region. 9 Several studies have demonstrated that Ondansetron can prevent PAS which made it a promising drug for prevention of postoperative complications like shivering, nausea, vomiting, post dural puncture headache. [10][11][12][13] when compared to other drugs, Ondansetron is devoid of hemodynamic side effects.…”