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Background Post-spinal shivering is a common complication after spinal anesthesia with a high incidence among orthopedic patients. Untreated shivering may predispose to exacerbation of wound pain, increased metabolic demand, oxygen consumption, and hemostatic dysfunction. Various studies have been done on the effectiveness of preventing post-spinal shivering using ketamine and other drugs. However, little information on better prophylactic agents in terms of effectiveness and availability. Therefore, this study was intended to compare 0.25 mg/kg of Ketamine (K) versus 0.5 mg/kg of Tramadol (T) for the prevention of post-spinal shivering. Method A prospective cohort study design was employed on 516 patients undergoing orthopedic surgery under spinal anesthesia, and they were selected by a consecutive sampling technique. Patients were divided into two groups based on the anesthetist in charge. Patients who received an intravenous prophylactic dose of Ketamine before spinal anesthesia are called Ketamine groups and patients who received Tramadol are called Tramadol groups (control). The severity and incidence of shivering, blood pressure, heart rate, and axillary body temperature were measured and recorded for one hour at 10-min intervals during the intraoperative period. Descriptive statistics, chi-square, independent t-test, and multivariable logistic regression were used. Significance was declared at a p-value lower than 0.05. Results The overall incidence of post-spinal shivering was 187 (36.2%), of which it was 74 (28.7%) on ketamine and 113 (43.8%) on tramadol with a p-value of 0.001. The incidence of nausea and vomiting was 157 (60.9%) on tramadol and 8 (3.1%) on ketamine, with a p-value of 0.001. Patients aged 18–35 years (AOR 0.08 (0.02, 0.27), 36–55 years (AOR 0.24, 0.07, 0.81), and those patients with a prolonged duration of surgery (AOR 1.47 (1.37–1.58)) were more likely to experience post-spinal shivering. And Low-dose ketamine has a protective effect against developing post-spinal shivering with an AOR of 0.427 (0.28–0.63). Conclusion Low-dose ketamine is more effective in reducing the incidence and severity of shivering after spinal anesthesia. Therefore, we recommend using low-dose ketamine to be effective as a prophylactic for post-spinal shivering in those patients undergoing orthopedic surgery under spinal anesthesia.

Background: Postoperative pain can have immediate and long-term consequences, including poor outcomes and prolonged hospitalization. It can also lead to chronic pain if not treated. Wound site infiltration with local anesthetic agents provides desirable analgesia for postoperative pain relief. The purpose of this study was to compare the analgesic effectiveness of local wound infiltration with a mixture of bupivacaine and tramadol (BT) versus bupivacaine alone (BA) for postoperative analgesia. Method: A prospective cohort study design was employed on 120 patients who underwent elective lower abdominal surgery under general or spinal anesthesia and were selected by using a systematic random sampling technique. Patients were divided into two groups based on the anesthetist in charge of postoperative pain management. Patients who received BT at the end of surgery are called BT groups, and patients who received BA are called BA groups (control). Result: The median (interquartile range) of pain severity score was significantly lower in the BT group as compared to the BA group with a p-value of 0.001. And, the median time to first analgesic request in the BT group was significantly longer as compared to patients in the BA group, with a p-value of 0.001. Conclusion: Local wound infiltration with BT decreases the postoperative pain score, total analgesic consumption, and has a prolonged time to first analgesia request as compared to BA. Therefore, we recommend using a local wound infiltration with BT to be effective for postoperative analgesia in patients undergoing elective lower abdominal surgery under general or spinal anesthesia. Highlights

Background: Postoperative pain can cause immediate and extended consequences of poor outcome and result in extended hospitalization. It also progresses to chronic pain, if not intervening early. Wound site infiltration with a mixture of tramadol and bupivacaine is inexpensive, easy, and useful means of providing desirable analgesia for postoperative pain relief. The purpose of the study was to compare the analgesic effectiveness of bupivacaine with the tramadol combination and bupivacaine alone as part of postoperative pain management.Method: A prospective cohort study was employed on 120 patients who underwent elective lower abdominal surgery under general or spinal anesthesia with a systematic random sampling technique. Pain severity was measured by using a numerical rating scale, and the employment of additional analgesics was recorded for 24 hours between the two groups. The Mann-Whitney test and chi-square test were used to compare the median pain score and total analgesia consumption. Kaplan-Meier survival analysis was used to compare the time to first analgesic request between the two groups. Statistical significance was stated at a p value < 0.05 with a power of 95%.Result: Postoperatively, the median (interquartile range) of pain severity score was 1.0 (0-5) in the BT group compared with 5 (3-6) in the BA group. And, time to first analgesic request with the BT group, was 18 hours, 95% CI: (14.53- 21.47), had longer time compared to patients in the BA group was 6 hours, 95% CI:(4.48 - 7.71).Conclusion and Recommendation: Local wound infiltration with a mixture of Bupivacaine and Tramadol decreases the postoperative pain score, total analgesia consumption and has prolonged time to first analgesia request. Therefore, we recommend using a mixture of 0.25% bupivacaine with tramadol is effective for postoperative analgesia.