Use of oral tramadol to prevent perianesthetic shivering in patients undergoing transurethral resection of prostate under subarachnoid blockade

Abstract

Context:Under regional anesthesia, geriatric patients are prone to shivering induced perioperative complications that Anesthesiologists should prevent rather than treat.Aim:We investigated the prophylactic efficacy of oral tramadol 50 mg to prevent the perioperative shivering after transurethral resection of prostate (TURP) surgery under subarachnoid blockade (SAB). Shivering is usually overlooked in patients undergoing urological surgery under spinal anesthesia and may result in morbidity, prolonged hospital stay and increased financial burden. Use of prophylactic measures to reduce shivering in geriatric patients who undergo urological procedures could circumvent this. Oral formulation of tramadol is a universally available cost-effective drug with the minimal side-effects.Settings and Design:Prospective, randomized, double-blinded, placebo-controlled study.Patients and Methods:A total of 80 patients who were scheduled for TURP surgery under subarachnoid block were randomly selected. Group I and II (n = 40 each) received oral tramadol 50 mg and placebo tablet respectively. After achieving subarachnoid block, the shivering, body temperature (tympanic membrane, axillary and forehead), hemodynamic parameters and arterial saturation were recorded at regular intervals.Statistical Analysis Used:T-test, analysis of variance test, Z-test and Fisher exact test were utilized while Statistical Product and Service Solutions, IBM, Chicago (SPSS statistics (version 16.0)), software was used for analysis.Results:Incidence of shivering was significantly less in patients who received tramadol (7.5% vs. 40%; P < 0.01). The use of tramadol was associated with clinically inconsequential side-effects.Conclusion:We conclude that the use of oral tramadol 50 mg is effective as a prophylactic agent to reduce the incidence, severity and duration of perioperative shivering in patients undergoing TURP surgery under SAB.

Comparison the Effects of Oral Tizanidine and Tramadol on Intra- and Post-operative Shivering in Patients Underwent Spinal Anesthesia

“…They also act on the thermoregulatory center (temperature control) in the hypothalamus. [ 15 22 ] The results of this study showed that oral TI and Tramadol before surgery decrease intra- and post-operative shivering in patients underwent spinal anesthesia, while there was no significant difference among three groups in terms of some parameters including nausea, vomiting, and hemodynamics. The heart rate of patients in TI group was significantly lower than other groups in recovery.…”

“…Tewari et al ., in 2014 demonstrated the effect of 50 mg oral tramadol on decreasing shivering during TURP surgery with spinal anesthesia. [ 22 ] Moreover, they compared the effects of oral clonidine and tramadol for preventing shivering in patients underwent TURP with spinal anesthesia and found that both tramadol and clonidine were effective in reducing the severity and duration of shivering. [ 23 ]…”

“… 0 - No shivering 1 - Mild Fasciculations of face or neck 2 - Visible tremor involving more than one muscle group 3 - Gross muscular activity involving the entire body. [ 22 ] …”

Antishivering effect of intrathecal versus intravenous tramadol in patients undergoing urethroscopic lithotripsy under spinal anesthesia

“…Tewari et al, 22 study was done to evaluate the efficacy of oral tramadol (50 mg 2 h before surgery) to prevent perioperative shivering in patients undergoing transurethral resection of the prostate under spinal anesthesia. They found a significant reduction in the incidence and severity of perioperative shivering in the study group.…”

Use of Oral Tramadol to Prevent Post-anaesthetic Shivering in Patients Undergoing Surgery under Spinal Anaesthesia

“…6,8,9 Shivering also may interfere with the monitoring of the patient causing artifacts of electrocardiogram, blood pressure and pulse oxymetry. 7,10 Many therapeutic strategies for treating and prevention of shivering exist. The efficacy of various pharmacological and physical method has already been established.…”