Comparison of Tramadol and Dexmedetomidine for Treatment of Shivering During Spinal Anaesthesia in Caesarean Section

Abstract

BACKGROUND Shivering is one of the most frequent complications of spinal anaesthesia, which is very distressing for the patients as well as surgeons. Shivering increases metabolic rate, which causes increased oxygen consumption. Tramadol is opioid analgesic. It is commonly used for treatment of shivering. Dexmedetomidine is alpha-2 receptor agonist. It causes vasoconstriction by acting on vascular smooth muscles and prevents shivering. In this study, efficacy of Tramadol and Dexmedetomidine for treatment of post spinal shivering was compared. MATERIAL AND METHODS This study was prospective, double-blind, randomized controlled trial conducted in 50 patients of ASA grade I and II, ages between 18-40 years scheduled for caesarean section under spinal anaesthesia. Patients were divided in two groups of 25 each, receiving either Tramadol 0.5 mg/kg or Dexmedetomidine 0.5 µg/kg intravenously. Time of onset of shivering, time taken for cessation of shivering, recurrence and adverse effects were observed. RESULTS Both groups were demographically similar and comparable at baseline. Duration of surgery and onset of shivering were also similar in both groups. Dexmedetomidine taking significantly less time in treatment of shivering and having less recurrence rate in comparison to Tramadol. Nausea and vomiting were side effects of Tramadol only. Sedation was similar in both groups. CONCLUSION In conclusion both drugs are effective in treatment of shivering but Dexmedetomidine taking less time for cessation of shivering, less recurrence rate and having less side effects.

Intravenous dexmedetomidine versus tramadol for treatment of shivering after spinal anesthesia: a meta-analysis of randomized controlled trials

“…Figure 1 showed the flow chart of this meta-analysis. Thirteen studies were included, involving 864 patients (432 received dexmedetomidine and 432 tramadol) [9][10][11][12][13][14][15][16][17][18][19][20][21]. The characteristics of the identified clinical trials were displayed in Tables 1.…”

“…Surgeries were performed under spinal anesthesia in 12 studies [9][10][11][12][13][14][15][16][17][18][19][20] and under combined spinal and epidural anesthesia in one study [21]. In the included studies, 7 compared dexmedetomidine with tramadol [9][10][11][12][13][14][15] and the other 6 compared dexmedetomidine with tramadol and clonidine [16][17][18]20], pethidine [21] or butorphanol [19]. Because our study only compared dexmedetomidine with tramadol, clonidine, pethidine and butorphanol were neglected.…”

“…The sedation achieved is better in patients receiving dexmedetomidine than patients receiving tramadol. None of patients experiencing over sedation or respiratory depression is reported in the included studies [9][10][11][12][13][14][15][16][17][18][19][20][21]. Since the surgery is done under spinal anesthesia, the sedation seen with dexmedetomidine is beneficial for the surgeon, anesthetist as well as the patient, because it provides comfort and amnesia to the patient, cardiorespiratory stability and good surgical conditions during surgery.…”