Prevention of Shivering during Spinal Anesthesia: Comparison between Tramadol, Ketamine and Ondansetron

Abstract

Introduction: Shivering is an unpleasant experience after spinal anesthesia. We conducted this study to evaluate the efficacy of ondansetron, ketamine and tramadol for prevention of shivering.
 Methods: In this prospective, randomized controlled study, 120 patients aged 18-65 years of American Society of Anesthesiologist (ASA) physical status I&II undergoing various surgical procedures were included and allocated alternately to one of the 4 groups; Normal saline (Group1), Ondansetron 4mg (Group2), Ketamine 0.25mg/kg (Group3) and Tramadol 0.5mg/kg (Group4). Incidence of shivering, effect on hemodynamics, nausea, vomiting, sedation and emergence reactions were recorded. Data was analyzed using SPSS (The Statistical Package for Social Sciences) version 20.0 software.
 Results: The patients were comparable in terms of demographic variables, baseline temperature, type of surgery, median level of sensory blockade, duration of surgery and anesthesia. Shivering was present in 17 (56.7%), 5 (16.7%), 3 (10%) and 3 (10%) patients respectively in Group 1, 2, 3 and 4 which was statistically significant when compared to Group 1 (P=0.00) The odds of NS and ondansetron, NS and ketamine, NS and tramadol was 6.53, 11.76 and 11.76 respectively which showed that study drugs were effective in preventing shivering. None of the patients were sedated in Group 1 and 2. Mild to moderate sedation was present in Group 3 and 4 (P=0.00). None of the patients had drug related adverse reactions.
 Conclusions: Prophylactic use of ondansetron, low doses of ketamine and tramadol is effective in preventing shivering post spinal anesthesia without untoward effects.
 Keywords: Anesthesia spinal; Ketamine; Ondansetron; Shivering; Tramadol.

Efficacy and safety of prophylactic use of ketamine for prevention of postanesthetic shivering: A system review and meta analysis

“…We reviewed 30 full-text articles, after screening the titles and the abstracts. A total of 16 [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25] studies including 1485 patients met our selection criteria and were included in the analysis (Table 1).…”

“…Participants in seven trials [10,12,13,18,19,23,24] underwent operations under general anesthesia; participants in nine trials [11,14,15,16,17,20,21,22,25] were under spinal anesthesia. In 13 trials [10,12,14,15,16,17,18,19,20,21,22,23] ketamine was compared to placebo; in 4 trials [12,13,23,24] ketamine was compared to pethidine; in the other 4 trials [11,15,16,22] ketamine was compared to tramadol. Ketamine was also compared to ondansetron in 4 trials [10,15,17,21] .…”

“…In 13 trials [10,12,14,15,16,17,18,19,20,21,22,23] ketamine was compared to placebo; in 4 trials [12,13,23,24] ketamine was compared to pethidine; in the other 4 trials [11,15,16,22] ketamine was compared to tramadol. Ketamine was also compared to ondansetron in 4 trials [10,15,17,21] .…”

“…The administration time and routes were different among included trials. In 10 trials [11,14,15,16,17,20,21,22,23,25] the intervention drugs were given immediately after induction of anesthesia or intrathecal injection; in five trials [10,12,18,19,24] drugs were administrated before completion of the surgical procedure; in one trial [13] patients received study drugs before wound closure. Study drugs were given as an IV bolus in 14 trials [10][11][12][13][14][15][16][17][18][19][20][21][22]24] ; in two trials, patients received the study drugs epidurally [25] or intramuscularly [24] .…”

“…In 10 trials [11,14,15,16,17,20,21,22,23,25] the intervention drugs were given immediately after induction of anesthesia or intrathecal injection; in five trials [10,12,18,19,24] drugs were administrated before completion of the surgical procedure; in one trial [13] patients received study drugs before wound closure. Study drugs were given as an IV bolus in 14 trials [10][11][12][13][14][15][16][17][18][19][20][21][22]24] ; in two trials, patients received the study drugs epidurally [25] or intramuscularly [24] . In four trials [14,15,18,19] , patients underwent orthopedic surgery; patients in two studies [21,22] underwent abdominal surgery; patients in two studies [16,17] underwent cesarean section; patients in two studies [20,25] underwent urological surgery; in three trials, participants received ENT surgery [10] , endoscopic sinus surgery [12] , or tonsillectomy surgery…”