THE EFFECTIVENESS OF TRAMADOL AND PETHIDINE FOR THE MANAGEMENT OF SHIVERING DURING SPINAL ANAESTHESIA IN CESAREAN DELIVERY AND OTHER SURGERY

Md. Shah Alamgir*, Jahir Uddin Ahmed, Ruma Akter, Mehtab Uddin Ahmed and Tanzila Islam

ABSTRACT

Background: Spinal anaesthesia (or spinal anesthesia), also called spinal block, subarachnoid block, intradural block and intrathecal block, is a form of neuraxial regional anaesthesia involving the injection of a local anaesthetic or opioid into the subarachnoid space. It is a safe and effective form of anesthesia usually performed by anesthesiologists that can be used as an alternative to general anesthesia commonly in surgeries involving the lower extremities and surgeries below the umbilicus. Objective: The purpose of this prospective randomized clinical trial was to assess the effectiveness, potency, and adverse effects of tramadol and pethidine for the management of shivering during spinal anaesthesia in cesarean delivery and other surgery. Method: This prospective study was done at Manikganj 250 Bedded General Hospital, Manikganj where after approval from departmental review board and obtaining patient’s written informed consent, 50 ASA grade I and II parturients, who subsequently developed shivering during elective or emergency cesarean section under spinal anaesthesia were included in the study. Besides that 50 other patients who developed fissure, hernia, fistula, scrotal abscess and undergo appendicectomy were also induced in the study. Patients who developed either grade 3 or grade 4 shivering were divided into two groups, Group 1 and Group 2. Group 1 (n=50) received inj tramadol 0.5 mg/kg body weight and Group 2 (n=50) received inj pethidine 0.5 mg/kg body weight for treatment of shivering after delivery of the baby. Results: During the study, Onset of shivering and severity of shivering (shivering grade) were almost similar in both groups and differences were statistically not significant. Shivering disappeared in 99% patients who received tramadol and 97% patients who received pethidine. Regarding responsiveness to treatment between two groups was almost similar and differences were not significant. Both the drugs were found to be effective in treatment of shivering. Severity of shivering was unchanged in 1% patient in Group 1 and 3% patients in Group 2. Recurrence of shivering occurred 3% patients in Group 1 and 12.50% patients in Group 2 and the difference between two groups was statistically significant (P<0.01). Moreover, side effects were significantly higher in Group 2 than Group 1. Nausea in 9% patients and vomiting in 11% patients were found in Group 2 and nausea in 2% patient and vomiting in 3% patient were found in Group T. Differences were statistically significant in case of nausea (P<0.05) and vomiting (P<0.05). Pruritus were observed in no patient of Group 1 and in Group 2 pruritus was observed in 7% patients. Differences were statistically highly significant in case of pruritus (P<0.001). Conclusion: Though both tramadol (0.5mg/kg bodyweight) and pethidine(0.5mg/kg bodyweight) effectively control shivering in parturient during spinal anaesthesia. But tramadol offered rapid onset, less recurrence rate and less side effects like nausea, vomiting, dizziness and pruritus when compared to pethidine.

Keywords: Spinal Anesthesia, Shivering, Cesarean section, Other surgery.