Comparative Study Between Tramadol Hydrochloride and Pethidine for Control of Shivering Under Regional Anaesthesia in Obstetric Patients

Abstract

Background: Shivering is a common complication observed in post spinal anaesthesia. It can be veryunpleasant and physiologically stressful for the patients. Different drugs are used for prevention andtreatment of post spinal shivering.

Materials & Methods: This prospective, randomized, double blinded, comparative clinical study wasconducted in the department of Anaesthesioloy, Bangladesh Medical College Hospital, Dhanmondi,Dhaka from 1st June ‘2016 to 30th November 2016. This study was designed to evaluate the efficacy andside effects of tramadol hydrochloride comparing with pethidine in the treatment of shivering of pregnantpatients underwent cesarean section under spinal anaesthesia. Total 160 ASA grade-l & ll pregnantpatients of cesarean section under Sub arachnoid block, who shivered, were included in this study.Patients were randomly allocated into two groups. Group-T (n=80) received tramadol hydrochloride1mg/kg and Group-P (n= 80) received pethidine 0.5mg/kg body weight intravenously for treatment ofshivering and side effects were recorded and subsequently analyzed.

Results: Disappearance of shivering after treatment was significantly earlier in Group-T (3.09±0.86minutes) than in Group-P ((5.11±1.08 minutes) (p <0.01). Recurrence of shivering after treatment wassignificantly less in Group-T 2(2.5%) than Group-P 7(8.75%) (p<0.01). Adverse effects were significantlyhigher in Group-P than Group-T. Nausea in 5(6.25%) patients and vomiting in 4(5%) patients found inGroup-P and nausea in 1(1.25%) patients and vomiting in 1(1.25%) patient found in Group-T. Differenceswere statistically significant in case of nausea (p<0.01) and vomiting (p<0.01). Dizziness and pruritusobserved in no patient of Group-T and in Group-P dizziness observed in 5(6.25%) patients and pruritusobserved in 4(5%). Differences were statistically significant in case of dizziness (p<0.001) & pruritus(p<0.001).

Conclusion: Both tramadol hydrochloride and pethidine effectively controlled shivering in patientsduring cesarean section under spinal anaesthesia, but tramadol hydrochloride offered rapid onset, lessrecurrence, and fewer side effects when compared to pethidine in obstetric patients.

JBSA 2019; 32(2): 44-49