Intravenous dexmedetomidine v/s tramadol on post spinal anaesthesia shivering: A randomized, double blind and interventional study
Keywords:Dexmedetomidine, Regional anaesthesia, shivering, Tramadol
Introduction: Regional anaesthesia is widely used and safe anaesthetic technique. It leads to Intra/ post-operative shivering. There are various methods available to control. Tramadol is one of the most widely used to control shivering, however it is also associated with nausea and vomiting. Objective: To compare the efficacy of dexmedetomidine and tramadol in the treatment of post‑spinal anesthesia (SA) shivering as well as to compare their side‑effect profile. Methodology: This hospital based, prospective, randomized, double blinded, Superiority type of interventional study included 60 patients undergoing elective spinal anesthesia aged 20-60 years, ASA grade I and II, weighing 40-80 kilograms. Subjects were randomly allocated into two groups, to receive either 0.5 mcg/kg Dexmedetomidine (Group D) or 05 mg/kg Tramadol (or grpup T). The grade of shivering was assessed as per wrench (Grade 0: no shivering, Grade 1: One or more of the following: piloerection, peripheral vasoconstriction, peripheral cyanosis, but without visible muscles activity, Grade 2: Visible muscle activity confined to one muscle group, Grade 3: Visible muscle activity in more than one muscle group and Grade 4: Gross muscle activity involving the whole body). Result: Shivering was eliminated in all the patients who received either dexmedetomidine or tramadol. Time for unset of shivering and grade of shivering is quite similar in both study groups. Time to cessation of shivering was significantly earlier with dexmedetomidine (174.3±12.5) as compare with tramadol (279.6±15.9). Nausea and vomiting is found significantly higher (P value = 0.024) with tramadol.
De Witte J, Sessler DI. Perioperative shivering: Physiology and pharmacology. Anesthesiology, 96, 467 84 (2002).
Sessler D, Ponte J. Shivering during epidural anaesthesia. Anesthesiology. 72, 816-21. (1992)
Jain A, Gray M, Slisz S, Haymore J, Badjatia N, Kulstad E. Shivering treatments for targeted temperature management: A Review. J Neurosci Nurs, 50, 63–67 (2018).
Doufas AG, Lin CM, Suleman MI. et al. Dexmedetomidine and meperidine additively reduce the shivering threshold in humans. Stroke, 34, 1218–23 (2003).
Bicer C, Esmaoglu A, Akin A. Dexmedeomidine and meperidine prevent postanaesthetic shivering. Eur J Anaesthesiol, 23(2), 149–53(2006).
Entezariasl M, Isazadehfar K. Dexamethasone for prevention of postoperative shivering: a randomized double-blind comparison with pethidine. Int J. Prev. Med., 4(7), 818–84 (2013)
Norouzinia H, Heshmati F, Agdashy M. The effectiveness of dexamethasone on the prevention of postoperative shivering after general anesthesia. Urmia Med J., 20, 62–68 (2009).
Kundra TS, Kuthiala G, Shrivastava A, Kaur P. A comparative study on the efficacy of dexmedetomidine and tramadol on post-spinal anesthesia shivering. Saudi J Anaesth, 11, 2-8 (2017)
Geeta M, Kanchan G. Randomised double blind comparative study of Dexmedetomidine and tramadol for post spinal anaesthesia shivering. Indian J Anaesthesia., 58(3), 257-262 (2014).
Chauhan J, Rautela RS. Intravenous dexamethasone versus tramadol for prevention of shivering after general anaesthesia: a randomised double-blind placebo controlled trial. Acad. Anesthesiol. Int., 6(1), 118-124 (2021).
Kundra TS, Kuthiala G, Shrivastava A, Kaur P. A comparative study on the efficacy of dexmedetomidine and tramadol on post spinal anesthesia shivering. Saudi Journal of Anesthesia, 11(1), 2-8 (2017).
Shukla U, Malhotra K, Prabhakar T. A comparative study of the effect of clonidine and tramadol on post-spinal anaesthesia shivering. Indian J Anaesth. 55(3), 242-6 (2011)
Venkatraman R, Krishnamoorthy K, Anand P, Annadurai M. A prospective, randomized, double-blinded control study on comparison of tramadol, clonidine and dexmedetomidine for post spinal anesthesia shivering. Rev Bras Anestesiol. 68(1), 42-8 (2018).
Pausawasdi S, Jirasirithum S, Phanaral C. The use of tramadol hydrochloride in the treatment of post anaesthestic shivering. J Med Assoc Thai, 73, 16-20 (1990).
Javaherloroosh F, Akhondzadeh R. Effects of Tramadol on shivering post spinal anesthesia in elective caesarean section. Pak J Med Sci, 25(1), 12-17 (2009)
Fern L, Misiran K. Comparison of dexmedetomidine, pethidine and tramadol in the treatment of post-neuraxial anaesthesia shivering. Southern African Journal of Anaesthesia and Analgesia, 21(1), 14–18 (2015)
Maheshwari BS, Shah SK, Chadha IA. Tramadol and butrophanol for control of shivering: Randomised double blind comparative study. J Anaesth Clin Pharmacol., 24, 343–6 (2008).
Bajwa SJ, Gupta S, Kaur J, Singh A, Parmar S. Reduction in the incidence of shivering with perioperative dexmedetomidine: A randomized prospective study. J Anaesthesiol Clin Pharmacology, 28, 86–91 (2012).
Usta B, Gozdemir M, Demircioglu RI, Muslu B, Sert H, Yaldiz A. Dexmedetomidine for the prevention of shivering during spinal anesthesia. Clinics (Sao Paulo), 66(7), 1187-91 (2011).
How to Cite
Copyright (c) 2023 Pooja Bharti, Yogesh Chand Modi, Subhita Marodia, Pushpendra Bairwa
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.