A COMPARISON OF TRAMADOL AND DEXMEDETOMIDINE'S EFFECTIVENESS IN TREATING SHIVERING AFTER SPINAL ANESTHESIA

Abstract

BACKGROUND: Shivering is preceded by hypothermia and vasoconstriction. Shivering is an involuntary muscle activity that increases baseline metabolic heat output by around 600%. Shivering may result from cooling the hypothalamic preoptic region. Because it improves the amount of core hypothermia that may be tolerated by boosting the cutaneous thermal input to the central thermoregulatory system, warming the skin can assist treat shivering during regional anesthesia. Shivering is brought on by cooling the hypothalamic preoptic region. Shivering is caused by efferent impulses that are received by the medial forebrain bundle. The posterior hypothalamus was thought to be the origin of a central descending shivering pathway in the past. Mild perioperative hypothermia doubles the risk of morbid cardiac events in individuals with coronary artery disease or those at high risk of getting the illness.

AIM: This study compared and assessed the two medications, tramadol and dexmedetomidine, for their ability to decrease shivering that occurs after spinal anesthesia.

MATERIAL AND METHOD: This study used a double blind, randomized design and was carried out in the department of anesthesia. Regarding their involvement in the study and the use of their data for the ongoing research project, all participants provided their informed written consent. Shivering occurred in 100 of the 150 patients that were involved in this trial. These 100 patients, who were in ASA PS I, II, and III and ranged in age from 19 to 68, were scheduled to receive spinal anesthetic from the hospital. The patients were randomly assigned to one of two groups consisting of fifty patients each, to receive an intravenous infusion via syringe pump of either tramadol 0.5 mg/kg or dexmedetomidine 0.5μg/kg. The intensity of the shivering, when it began, when it ended, if it recurred, and any adverse effects were recorded at predefined intervals.

 RESULTS: Incidence of shivering among different surgical procedures. Out of 150 patients who initially recruited in the study, 20 were from orthopaedic surgery, 39 from general surgery, 80 from uro-surgery and 11 from gynaecological surgery. Among those patients 12 (5 Group A and 07 Group B) from orthopaedics, 37 (21 in Group, 16 in Group B) from general surgery, 42 (19 Group A, 23 Group B) from uro-surgery and 9 (4 in Group, 5 in Group B) from gynaecological surgical patients developed shivering.

CONCLUSION: Both dexmedetomidine (0.5μg/kg) and tramadol (0.5 mg/kg) are effective in treating post-spinal anaesthesia shivering; however, dexmedetomidine needed less time than tramadol to totally cease the shivering. Moreover, dexmedetomidine has less adverse effects, such as nausea and vomiting. The recurrence of shivering was also greatly reduced with dexmedetomidine in comparison to tramadol. To confirm that dexmedetomidine is a particularly effective anti-shivering drug, more research with varying dosages is needed.

KEYWORDS: Spinal Anesthesia, Tramadol, Shivering, Dexmedetomidine and Induced hypothermia