Effects of oral premedication with tramadol, pregabalin or clonidine on shivering after spinal anaesthesia in patients undergoing hysteroscopic procedures

Gaballah, Khaled M; Abdallah, Sabry I

doi:10.5114/ait.2020.97579

Cited by 3 publications

(3 citation statements)

References 34 publications

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“…7 Shivering is a physiological compensatory response to core hypothermia due to redistribution of heat as a result of vasodilation from chemical sympathectomy of spinal anaesthesia. 9 While cold induced thermoregulatory shivering remains the most common aetiology, pain, disinhibited spinal reflexes, decresed sympathetic activity and respiratory alkalosis are the other possible cause. 8 Shivering is associated with important adverse effect especially to those recovering from anesthesia.…”

Section: Introductionmentioning

confidence: 99%

“…Increased muscular activity during shivering may increase oxygen demand by as much as 500% and also leads to increased carbon dioxide production that leads to hypoxemia, hypercarbia and lactic acidosis which may be deleterious to the patient with limited cardio respiratory reserve. 6,8,9 Shivering also may interfere with the monitoring of the patient causing artifacts of electrocardiogram, blood pressure and pulse oxymetry. 7,10 Many therapeutic strategies for treating and prevention of shivering exist.…”

Section: Introductionmentioning

confidence: 99%

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Use of Oral Tramadol to Prevent Post-anaesthetic Shivering in Patients Undergoing Surgery under Spinal Anaesthesia

Acharya

Dangol

2023

Nep. Med. Coll. J.

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Shivering is a common and distressing problem after spinal anaesthesia which occurs due to heat loss and core to peripheral redistribution of body heat, resulting in reduction of core body temperature. Post anaesthetic shivering has deleterious metabolic and cardiovascular effect which should ideally be prevented by pharmacological methods that are economically and practically feasible in all settings compared to many physical methods. Therefore, this study was conducted using a centrally acting analgesic, oral Tramadol hydrochloride prophylactically for the prevention of perianaesthetic shivering after spinal anaesthesia. This prospective observational study was carried out in 106 patients of ASA I or II, aged 15 to 70 yrs of age undergoing lower limb or lower abdominal surgery under spinal anaesthesia. Postanaesthetic shivering was evaluated during the surgery. Shivering was observed in 11 (10.4%) patients and among them 2 (1.9%) patients had grade 1, 6 (5.7%) patients had grade 2, 2 (1.9%) patients had grade 3 and 1 (0.9%) patients had grade 4 type of shivering. Sedation was observed in 19 (17.9%) patients. The result of this study concluded that oral tramadol is very safe and superior to various drugs studied till date and can be used prophylactically as a part of premedication for the prevention of postanaesthetic shivering in patients undergoing surgery under spinal anaesthesia.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Use of Oral Tramadol to Prevent Post-anaesthetic Shivering in Patients Undergoing Surgery under Spinal Anaesthesia

Acharya

Dangol

2023

Nep. Med. Coll. J.

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“…The inevitable degree of sympathetic block during spinal anesthesia may cause hemodynamic disturbances. It possesses the risk of minor (e.g., shivering) and severe adverse events (e.g., spinal abscess or hematoma) [ 8 , 9 ]. The most popular—single-shot spinal anesthesia—is non-titratable; thus, the block characteristics cannot be adjusted during surgery.…”

Section: Introductionmentioning

confidence: 99%

The Density of Different Local Anesthetic Solutions, Opioid Adjuvants and Their Clinically Used Combinations: An Experimental Study

et al. 2021

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Various opioids are added to local anesthetic solutions for spinal anesthesia. This may change the final density of the local anestetic (LA) mixture. This effect regarding current concepts in spinal anesthesia needs to be re-evaluated. In order to re-evaluate such effects, hyperbaric and isobaric local anesthetic (LA) solutions were mixed with opioid adjuvants (A) using the equipment available in the operating room. Ten density measurements for each composition (LA-A) were performed. The density change of 0.0006 g/mL was regarded as significant. Measured densities were also compared with theoretical values calculated using Hare’s. As a result, the addition of an opioid adjuvant caused a significant reduction in the final density of the LA-A solution. In hyperbaric LA mixtures, it did not change the baricity from hyperbaric to isobaric. However, the addition of highly hypobaric fentanyl 0.99360 g/mL (SD ± 0.00004) changes all isobaric LA solutions baricity to hypobaric. The comparison of measured and theoretical densities revealed significant differences (p > 0.05). However, the absolute reduction reached 0.0006 g/mL in only two LA-A compositions. We conclude that the addition of fentanyl to isobaric LA results in a hypobaric solution that may affect the distribution of the block. The inadequacy of LA-A in a clinical setting is unlikely to influence block characteristics.

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Efficacy of Prophylactic Ketamine, Ondansetron, and Pethidine in Preventing Perioperative Shivering in Patients Undergoing Elective Knee Replacement Surgery Under Spinal Anaesthesia

R¹,

Sethi²,

Singh³

et al. 2022

Turk J Anaesthesiol Reanim

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Objective Perioperative shivering is a very common complication. Despite the vast array of knowledge regarding perioperative shivering and its after-effects, its prophylaxis is often overlooked. The study aims to compare the efficacy and safety of low-dose ketamine, ondansetron, and pethidine in the prevention of perioperative shivering in patients undergoing total knee replacement surgery under the subarachnoid block. Methods In this randomized controlled study, 203 patients aged 18-75 were included and allocated to one of the 4 groups; normal saline (group S), ondansetron 4 mg (group O), ketamine 0.25 mg kg −1 (group K), and pethidine 0.25 mg kg −1 (group P). Side effects, namely hypotension, nausea and vomiting, sedation, hallucinations, and respiratory depression were recorded. Results Perioperative shivering was present in 22 (44%), 8 (16%), 4 (7.84%), and 4 (7.69%) patients respectively in group S, O, K, and P, which was statistically significant when compared to group S with group K and P ( P < .01). No difference in the incidence of hypothermia was observed across the groups ( P < .17). A significantly lower incidence of hypotension was observed in group K. In group K, 5.9% of the patients were scored as being under severe sedation, according to the modified Wilson sedation scale. There was no incidence of hallucination or respiratory depression observed in any of the groups. Conclusions Patients undergoing total knee replacement surgeries are highly predisposed to the development of hypothermia. Temperature monitoring is thus imperative for all patients. Prophylactic administration of low-dose ketamine or ondansetron or low-dose pethidine produces a significant anti-shivering effect without any significant side effects. However, low-dose ketamine has the advantages of a lower incidence of hypotension, nausea, and vomiting than pethidine.

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Effects of oral premedication with tramadol, pregabalin or clonidine on shivering after spinal anaesthesia in patients undergoing hysteroscopic procedures

Cited by 3 publications

References 34 publications

Use of Oral Tramadol to Prevent Post-anaesthetic Shivering in Patients Undergoing Surgery under Spinal Anaesthesia

Use of Oral Tramadol to Prevent Post-anaesthetic Shivering in Patients Undergoing Surgery under Spinal Anaesthesia

The Density of Different Local Anesthetic Solutions, Opioid Adjuvants and Their Clinically Used Combinations: An Experimental Study

Efficacy of Prophylactic Ketamine, Ondansetron, and Pethidine in Preventing Perioperative Shivering in Patients Undergoing Elective Knee Replacement Surgery Under Spinal Anaesthesia

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