Effect of Tramadol and Pethidine on Shivering during Cesarean Section under Spinal Anaesthesia

Abstract

Introduction: Shivering is a common complication observed in post spinal anaesthesia. Shivering can be very unpleasent and physiologically stressful for the patients. Different drugs are used for prevention and treatment of post spinal shivering.

Objective: This study was designed to evaluate the efficacy and side effects of tramadol comparing pethidine in treatment of shivering on pregnant patients during cesarean section under spinal anaesthesia.

Methods: This prospective clinical type of study was conducted in the department of Anaesthesia and Intensive Care at Combined Military Hospital, Dhaka from July 2011 to June 2012. One hundred twenty American Society of Anaesthesiologist (ASA) grade I and II pregnant patients of cesarean section under spinal anaesthesia, who had shivering, were included in this study. Patients were divided into two groups. Group T(n=60) received tramadol 0.5mg/kg and Group P(n=60) received pethidine 0.5mg/kg body weight intravenously for treatment of shivering. Grade of shivering, disappearance of shivering and side effects were recorded and subsequently analyzed.

Results: Disappearance of shivering after treatment was significantly earlier in Group T (3.09±0.86 minutes) than Group P (5.11±1.08 minutes) (P<0.01). Recurrence of shivering after treatment was significantly less in Group T 2(3,33%) than Group P 7(11.67%) (P<0.01). Side effects were significantly higher in Group P than Group T. Nausea in 5(8.33%) patients and vomiting in 4(6.67%) patients found in Group P and nausea in 1(1.67%) patient and vomiting in 1(1.67) patient found in Group T. Differences were statistically significant in case of nausea (P<0.05) and vomiting (P<0.05). Dizziness and pruritus observed in no patient of group of T and in Group P dizziness observed in 6(10%) patients and pruritus observed in 3(5%) patients. Differences were statistically highly significant in case of dizziness (P<0.001) and pruritus (P<0.001).

Conclusion: Both tramadol and pethidine effectively controlled shivering in patients during cesarean section under spinal anaesthesia. But tramadol offered rapid onset, less recurrence and fewer side effects when compared to pethidine.

Journal of Armed Forces Medical College Bangladesh Vol.10(2) 2014