Research Article

A Comparison of the Therapeutic Effect of Tramadol and Meperidine for Treatment of Shivering after Spinal Anesthesia in Elective Caesarean Section

Abstract

Background: In most operating and recovery rooms, shivering is controlled by the use of humidifiers, warming blankets, and inhalation of humidified heated oxygen. However, pharmacological control is an effective alternative treatment modality. This study was designed to compare the efficacy of tramadol versus meperidine in the treatment of shivering after spinal anesthesia.
Methods: In a double-blind randomized clinical trial, we studied 70 obstetric patients with ASA class  I or II who had shivering following spinal anesthesia (SA) with 0.5% bupivacaine. All patients were randomly allocated to one of the two groups receiving tramadol 0.5 mg/kg (group T, n = 35), or meperidine 0.5 mg/kg (group M, n = 35). The onset of cessation of shivering, the efficacy of agents for treatment of shivering, hemodynamic variables, sedation score, pruritus, nausea and vomiting were assessed.
Results: Shivering ceased after 2.57±2.26 and 6.24±4.76 minutes in group T and group M respectively (p=0. 03). The differences before and after injection of meperidine for the heart rate, respiratory rate and arterial oxygen saturation were significant (p<0.001). Nausea and vomiting occurred significantly more frequently in the meperidine group compared to the tramadol group (p<0.001).
Conclusion: Tramadol is a more effective agent than meperidine in the treatment of post spinal shivering, with lower early side effects in obstetric patients. 

Horn EP, Sessler DI, Standl T, Schroeder F, Bartz HJ, Beyer JC, et al. Non-thermoregulatory shivering in patients recovering from isoflurane or desflurane anesthesia. Anesthesiology. 1998; 89(4):878-86.

Macario A, Weinger M, Truong P, Lee M. Which clinical anesthesia outcomes are both common and important to avoid? The perspective of a panel of expert anesthesiologists. Anesth Analg. 1999; 88(5):1085-91.

Bay J, Nunn JF, Prys-Roberts C. Factors influencing arterial PO2 during recovery from anaesthesia. Br J Anaesth. 1968; 40(6):398-407.

Pflug AE, Aasheim GM, Foster C, Martin RW. Prevention of post-anaesthesia shivering. Can Anaesth Soc J. 1978; 25(1):43-9.

Chan AM, Ng KF, Tong EW, Jan GS. Control of shivering under regional anesthesia in obstetric patients with tramadol. Can J Anaesth. 1999; 46(3):253-8.

Sessler DI, Rubinstein EH, Moayeri A. Physiologic responses to mild perianesthetic hypothermia in humans. Anesthesiology. 1991; 75(4):594-610.

Pausawasdi S, Jirasirithum S, Phanarai C. The use of tramadol hydrochloride in the treatment of post-anesthetic shivering. J Med Assoc Thai. 1990; 73(1):16-20.

Rosa G, Pinto G, Orsi P, de Blasi RA, Conti G, Sanitá R, La Rosa I, Gasparetto A. Control of post anaesthetic shivering with nefopam hydrochloride in mildly hypothermic patients after neurosurgery. Acta Anaesthesiol Scand. 1995; 39(1):90-5.

Yared JP, Starr NJ, Hoffmann-Hogg L, Bashour CA, Insler SR, O'Connor M, et al. Dexamethasone decreases the incidence of shivering after cardiac surgery: a randomized, double-blind, placebo-controlled study. Anesth Analg. 1998; 87(4):795-9.

Pauca AL, Savage RT, Simpson S, Roy RC. Effect of pethidine, fentanyl and morphine on post-operative shivering in man. Acta Anaesthesiol Scand. 1984; 28(2):138-43.

Wang JJ, Ho ST, Lee SC, Liu YC. A comparison among nalbuphine, meperidine, and placebo for treating postanesthetic shivering. Anesth Analg. 1999; 88(3):686-9.

Ekemen S, Yelken B, Ilhan H, Tokar B. A comparison of analgesic efficacy of tramadol and pethidine for management of postoperative pain in children: a randomized, controlled study. Pediatr Surg Int. 2008; 24(6):695-8.

Raffa RB, Friderichs E, Reimann W, Shank RP, Codd EE, Vaught JL. Opioid and nonopioid components independently contribute to the mechanism of action of tramadol, an 'atypical' opioid analgesic. J Pharmacol Exp Ther. 1992; 260(1):275-85.

Shen X, Wang F, Xu S, Ma L, Liu Y, Feng S, et al. Comparison of the analgesic efficacy of preemptive and preventive tramadol after lumpectomy. Pharmacol Rep. 2008; 60(3):415-21.

Heid F, Grimm U, Roth W, Piepho T, Kerz T, Jage J. Intraoperative tramadol reduces shivering but not pain after remifentanil-isoflurane general anaesthesia. A placebo-controlled, double-blind trial. Eur J Anaesthesiol. 2008; 25(6):468-72.

De Witte JL, Kim JS, Sessler DI, Bastanmehr H, Bjorksten AR. Tramadol reduces the sweating, vasoconstriction, and shivering thresholds. Anesth Analg. 1998; 87(1):173-9.

De Cosmo G, Congedo E, Lai C, Primieri P, Dottarelli A, Aceto P. Preoperative psychologic and demographic predictors of pain perception and tramadol consumption using intravenous patient-controlled analgesia Clin J Pain. 2008; 24(5):399-405.

Kayser V, Besson JM, Guilbaud G. Evidence for a noradrenergic component in the antinociceptive effect of the analgesic agent tramadol in an animal model of clinical pain, the arthritic rat. Eur J Pharmacol. 1992; 224(1):83-8.

Delaunay L, Bonnet F, Liu N, Beydon L, Catoire P, Sessler DI. Clonidine comparably decreases the thermoregulatory thresholds for vasoconstriction and shivering in humans. Anesthesiology. 1993; 79(3):470-4.

Schwarzkopf KR, Hoff H, Hartmann M, Fritz HG. A comparison between meperidine, clonidine and urapidil in the treatment of postanesthetic shivering. Anesth Analg. 2001; 92(1):257-60.

Hadi MA, Kamaruljan HS, Saedah A, Abdullah NM. A comparative study of intravenous patient-controlled analgesia morphine and tramadol in patients undergoing major operation. Med J Malaysia. 2006; 61(5):570-6.

Bhatnagar S, Saxena A, Kannan TR, Punj J, Panigrahi M, Mishra S. Tramadol for postoperative shivering: a double-blind comparison with pethidine. Anaesth Intensive Care. 2001; 29(2):149-54.

De Witte J, Deloof T, de Veylder J, Housmans PR. Tramadol in the treatment of postanesthetic shivering. Acta Anaesthesiol Scand. 1997 ; 41(4):506-10.

Crossley AW, Mahajan RP. The intensity of postoperative shivering is unrelated to axillary temperature. Anaesthesia. 1994; 49(3):205-7.

Chan AM, Ng KF, Tong EW, Jan GS. Control of shivering under regional anesthesia in obstetric patients with tramadol. Can J Anaesth. 1999; 46(3):253-8.

Mohta M, Kumari N, Tyagi A, Sethi AK, Agarwal D, Singh M. Tramadol for prevention of postanaesthetic shivering: a randomised double-blind comparison with pethidine. Anaesthesia. 2009; 64(2):141-6.

Bansal P, Jain G. Control of shivering with clonidine, butorphanol, and tramadol under spinal anesthesia: a comparative study. Local Reg Anesth. 2011; 4:29-34.

Joshi C, Ambi U, Mirji P. Can we use Tramadol as an anti-shivering agent? Indian J Anaesth. 2012; 56(1):91-2.

Yousuf B, Samad K, Ullah H, Hoda MQ. Efficacy of tramadol in preventing postoperative shivering using thiopentone or propofol as induction agent: A randomized controlled trial. J Anaesthesiol Clin Pharmacol. 2013; 29(4):521-5.

Heidari SM, Rahimi M, Soltani H, Hashemi SJ, Shabahang S. Premedication with oral tramadol reduces severity of postoperative shivering after general anesthesia. Adv Biomed Res. 2014; 3:64.

Mittal G, Gupta K, Katyal S, Kaushal S. Randomised double-blind comparative study of dexmedetomidine and tramadol for post-spinal anaesthesia shivering. Indian J Anaesth. 2014; 58(3):257-62.

Emadi A. Comparison postanesthetic shivering beetwin tramadol & pethidin. J Mazandaran University of Medical Sciences. 1389; 20: 78. [In Persian].

Tsai YC, Chu KS. A comparison of tramadol, amitriptyline, and meperidine for postepidural anesthetic shivering in parturients. Anesth Analg. 2001; 93(5):1288-92.

Nasseri K, Ahsan B, Shami S, Kohan M, Farhadifar F. Compare the effects of tramadol and pethidine-like drugs in the prevention of shivering after anesthesia. Iran Journal of Surgery. 1385; 14: 2. [In Persian].

De Witte J, Rietman GW, Vandenbroucke G, Deloof T. Post-operative effects of tramadol administered at wound closure. Eur J Anaesth. 1998; 15(2):190–195.

Eggers KA, Power I. Tramadol. Br J Anesth. 1995; 74(3):247–9.

Chan AM, Ng KF, Tong EW, Jan GS. Control of shivering under regional anesthesia in obstetric patients with tramadol. Can J Anesth. 1999; 46(3):253–8.

Alfonsi P. Postanesthetic shivering: Epidemiology, pathophysiology, and approaches to prevention and management. Drugs. 2001; 61(15):193–205.

Chen SC, Tang CS, Chen YT, Ko CJ, Yu KL, Tseng CK, et al. [The evaluation of the anti-shivering effect of tramadol during epidural anesthesia] Gaoxiong yi xue ke xue za zhi = The Kaohsiung J Med Sc. 1994; 10(11):632–9.

De Witte J, Deloof T, de Veylder J, Housmans PR. Tramadol in the treatment of postanesthetic shivering. Acta anaesthesiologica Scand. 1997; 41(4):506–10.

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IssueVol 1 No 2 (2015): Spring QRcode
SectionResearch Article(s)
Keywords
spinal anesthesia tramadol meperidine shivering

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How to Cite
1.
Manouchehrian N, Mohammadian A, Sanie Jahromi MS, Faridi Tazeh kand N, Sanatkar M. A Comparison of the Therapeutic Effect of Tramadol and Meperidine for Treatment of Shivering after Spinal Anesthesia in Elective Caesarean Section. Arch Anesth & Crit Care. 2015;1(2):50-54.