Comparing the Effects of Low Dose of Ketamine, Tramadol, and Ondansetron in Prevention of Post Spinal Anesthesia Shivering in Cesarean Section (original) (raw)
Related papers
2017
Background: Shivering is a frequent and undesirable complication of spinal anesthesia. It is a physiologic response to increase the body core temperature in an attempt to raise metabolic heat production. However, shivering may trigger myocardial ischemia; increase intraocular and intracranial pressures, increase wound pain, delay wound healing and interfere with pulse rate, blood pressure and electrocardiogram monitoring. We aimed to compare the efficacy of intravenous (IV) ketamine with IV tramadol for the prevention of shivering in patients who underwent cesarean delivery under spinal anesthesia. Patients and methods: A prospective, randomized, double-blind study was conducted. One hundred and twenty-three American Society of Anesthesiologist I and II patients, aged between 18 and 39 years, who underwent cesarean section were included in the study. Patients were randomly allocated to one of three groups: group S (n=41; control group) received saline, group K (n=41) received ketamine 0.2 mg/kg and group T (n=41) received tramadol 0.5 mg/kg. Incidence and grade of shivering and side effects between the treatment groups were recorded. Results: The incidence of shivering was significantly reduced in the ketamine and tramadol groups (41.5% and 53.7%, respectively) compared to the saline group (70.7%; p=0.028). Grade 3 shivering occurred in 16 (39%) patients in the saline group, compared to 9 (22%) in the tramadol group and 8 (19.5%) in the ketamine group (p=0.011). Only two cases in the saline group developed grade 4 shivering (p,0.01). Neonatal outcome and perioperative complications were comparable among the three groups. Conclusion: The prophylactic administration of low-dose IV ketamine or IV tramadol is effective for reducing the incidence and intensity of shivering. We recommend low-dose IV ketamine or tramadol prophylaxis for parturients undergoing cesarean section under spinal anesthesia. Keywords: cesarean delivery, spinal anesthesia, shivering, prophylaxis, ketamine, tramadol, efficacy
Anaesthesia, Pain & Intensive Care
Background & objective: Perioperative shivering after spinal anesthesia for cesarean section is a common and unpleasant complication. Currently pethidine is being used but the search continues to look for other agents with faster action and with fewer side effects. Tramadol is a potential anti-shivering drug with modulation of central thermoregulation. We compared the efficacy of tramadol versus pethidine in the treatment of perioperative shivering of patients undergoing cesarean section under spinal anesthesia. Methodology: After institutional ethical review committee approval, 42 patients undergoing cesarean section under spinal anesthesia, who experienced shivering, were randomized into two groups, Group T (n = 21) received 1 mg/kg tramadol and Group P (n = 21) received 0.5 mg/kg pethidine. The outcome measures included the time taken to cessation of shivering after the medication, recurrence of shivering and the incidence of side effects. Results: The parturients with mean age 3...
Journal of Clinical Anesthesia, 2013
To compare the efficacy and safety of ketamine 0.25 mg/kg with ketamine 0.5 mg/kg to prevent shivering in patients undergoing Cesarean delivery. Prospective, randomized, double-blinded, placebo-controlled study. Operating rooms and postoperative recovery rooms. 120 ASA physical status 1 and 2 pregnant women scheduled for Cesarean delivery during spinal anesthesia. Patient characteristics, anesthetic and surgical details, Apgar scores at 1 and 5 minutes, and side effects of the study drugs were recorded. Heart rate, mean arterial pressure, oxygen saturation via pulse oximetry, tympanic temperature, severity of shivering, and degree of sedation were recorded before intrathecal injection and thereafter every 5 minutes. Patients were randomized to three groups: saline (Group C, n=30), intravenous (IV) ketamine 0.25 mg/kg (Group K-0.25, n=30), or IV ketamine 0.5 mg/kg (Group K-0.5, n=30). Grade 3 or 4 shivering was treated with IV meperidine 25 mg and the prophylaxis was regarded as ineffective. The number of shivering patients was significantly less in Group K-0.25 and in Group K-0.5 than in Group C (P = 0.001, P = 0.001, respectively). The tympanic temperature values of Group C were lower at all times of the study than in either ketamine group. Median sedation scores of Group K-0.5 were significantly higher than in Group K-0.25 or Group C at 10, 20, 30, and 40 minutes after spinal anesthesia. Prophylactic IV ketamine 0.25 mg/kg was as effective as IV ketamine 0.5 mg/kg in preventing shivering in patients undergoing Cesarean section during spinal anesthesia.
2018
Background: Shivering is a frequently occurring complication of spinal anaesthesia. It is more common in patients undergoing abdomen surgery, procedures of long duration and extremes of age. It has deleterious consequences on patient recovery unless prophylactic steps are taken to prevent this complication. Aim: To compare the prophylactic use of I/V tramadol with I/V ketamine on thefrequency of intraoperative shivering inspinal anesthesia for patients undergoing caesarean section. Methods: A prospective randomized study was conducted in 400 parturients of ASA I and II status undergoing cesarean section. They were randomly divided into two groups n=200 each. Patients received prophylactic i/v 0.5mg Ketamine (K Group) and 2mg/kg i/v tramadol (T Group). Spinal anaesthesia was administered with injection bupivacaine. After assessment of adequacy of block, frequency of shivering was recorded. Results: In this study of 400 patients, shivering was seen in 111 patients (27.75%). Shivering ...
International Journal of Scientific and Research Publications (IJSRP), 2021
BACKGROUND: Shivering is an increased muscular activity that can caused by spinal anaesthesia. Dexamethasone is a steroid drug that can lower the incidence of post anaesthetic shivering by decreasing the dermal temperature and core temperature gradient. This study aimed to compare the effect of dexamethasone and pethidine in lowering the incidence of shivering in caesarean section patients under spinal anaesthesia. METHOD: This was a post-test control group clinical trial study conducted in Central Surgical Unit at RSUP H Adam Malik Medan and University of North Sumatera Hospital for 3 months. A total of 81 samples were divided into 3 groups (pethidine; dexamethasone; normal saline, NS). Randomized triple blind method was used. The variables were tested using chi square (p<0,05). RESULT: Shivering was found in all study groups (pethidine 25,9%; dexamethasone 37%; NS 59,3%). The percentages of grade 0 shivering were 74,1%, 63%, and 40,7% in pethidine, dexamethasone, and NS group respectively (p value 0,011). There was no incidence of grade 4 shivering in pethidine group. CONCLUSION: The effects of pethidine, dexamethasone, and NS in lowering the incidence of post anaesthesia shivering in caesarean section patients under spinal anaesthesia were statistically significant (p value 0,04). There was a significant difference in shivering incidence based on shivering assessment scale among all study groups (p value 0,011).
Asian biomedicine
Background: Use of meperidine for the treatment of post-anesthetic shivering (PS) after neuraxial opioids is limited by risk of respiratory depression. Objective: To compare the efficacy of tramadol, nalbuphine, ondansetron and a placebo in the treatment of PS after spinal anesthesia in cesarean section patients. Methods: Two hundred eighty parturients who developed moderate to severe shivering and required treatment after cesarean delivery under spinal anesthesia with bupivacaine and intrathecal morphine 0.2 mg were randomized into 4 groups. Group T, Group N, Group O and Group P were given tramadol 0.5 mg/kg, nalbuphine 0.05 mg/kg, ondansetron 0.1 mg/kg and normal saline 5 mL IV, respectively. The patients were evaluated at 15 minutes after treatment and were observed for a recurrence of PS within 4 hours in a double-blinded fashion. Results: The treatment success rate (no or mild shivering) of PS in groups T, N, O and P were 88, 81, 61 and 36 %, respectively (p<0.001). The treatment success rate of groups T vs P, N vs P, O vs P, T vs O and N vs O were significantly different (p<0.001, 0.001, 0.003, <0.001, and 0.009, respectively). The success rate between groups T vs N was not significantly different (p=0.223). Recurrence rate of PS in groups T, N, O and P were 14 %, 15 %, 11 % and 28 %; p=0.329. Other side effects such as pruritus, nausea/vomiting, and dizziness were few and treatable. Conclusion: Tramadol, nalbuphine and ondansetron were efficacious in the treatment of PS after intrathecal morphine in cesarean section patients with low recurrence rates. Tramadol and nalbuphine were superior to ondansetron in the treatment of PS.
Background: Spinal anesthesia is the preferred method of anesthesia during cesarean section; nonetheless, it is associated with serious side effects both on mother and fetus, including spinal anesthesia-induced shivering and hypotension. Previous research suggests that serotonin may have a role in the occurrence of hypotension, bradycardia, and shivering perioperatively. We investigated the efficacy of ondansetron, a serotonin receptor antagonist, on the incidence of spinal anesthesia-induced shivering, hypotension, nausea, vomiting, and other potential problems in elective cesarean sections in this prospective double-blind randomized control trial research. This study was carried out in Palestine, West Bank, Nablus city, at the cesarean section surgery rooms and post-anesthesia care unit at Rafidia governmental hospital. Eighty full-term elective cesarean section parturients (Age 18-50 years) with ASA 1 or 2 were recruited and randomly assigned to one of two groups: prophylactic IV ondansetron group and placebo 0.9 % saline control. The incidence of spinal anesthesia-induced shivering and hypotension were the primary outcomes, whereas the secondary outcomes were perioperative bradycardia, nausea, vomiting, headache, pain, pruritus, dizziness, respiratory depression, and parturient satisfaction. Results: Intraoperatively, the incidence of intraoperative hypotension and dizziness was significantly lower in the ondansetron group than in the control group (22.5 % vs. 62.5 %, respectively; P< 0.001), as were the incidences and intensity of intraoperative shivering was lower than the control group (12.5 % vs. 32.5 %, respectively; P = 0.032). The intensity of intraoperative nausea was lower in the ondansetron group than in the control group (P = 0.049). Postoperatively, the incidence of postoperative dizziness was lower in the ondansetron group than in the control group (5 % vs. 37.5 %, respectively; P = 0.001), as did the incidence and intensity of postoperative shivering (12.5 % vs. 37.5 %, respectively; P = 0.01). The incidence and severity of postoperative nausea were lower in the ondansetron group than in the control group (17.5 % vs. 40 %, respectively; P = 0.026), as did the incidence of postoperative vomiting (25.5 % vs. 2.5 %, respectively; P = 0.014). Conclusion: Prophylactic 4 mg IV ondansetron can considerably reduce the occurrence of spinal anesthesia-induced shivering and hypotension, dizziness, nausea, and vomiting, and enhance the parturient favorable rating in cesarean section clients.
Archives of Anesthesia and Critical Care
Background: Shivering refers to a series of repetitive involuntary movements of the skeletal muscles commonly occurring during spinal anesthesia. Regional anesthesia (both spinal and Epidural) reduces vasoconstriction and shivering threshold to 6 degrees Celsius above the surface of the block. The aim of this study was to determine the effect of prophylactic administration of intravenous paracetamol in controlling shivering during and after cesarean section under spinal anesthesia. Methods: In a double-blind randomized clinical trial in the Department of Anesthesiology of Tabriz on patients undergoing cesarean section with spinal anesthesia, the effect of prophylactic administration of paracetamol IV in controlling shivering during and after cesarean section under spinal anesthesia was evaluated. Results: The mean gestational age of patients was 37.94±1.07 weeks in paracetamol group and 37.58±2.07 weeks in the control group (p=0.278). The mean shivering scores of patients in paracet...
Life and Science
Objective: To compare the effect of intravenous ondansetron versus intravenous tramadol on post-spinal shivering and nausea/vomiting in caesarean sections. Study Design: Prospective comparative study Place and Duration of Study: The study was carried out at Department of Anesthesia, Frontier Corps Hospital Quetta from 2nd July 2019 to 1st November 2019. Materials and Methods: Ninety patients, who were scheduled for elective cesarean section under spinal anesthesia were randomly allocated to one of three study groups to receive intravenous ondansetron (group O), tramadol (group T) or normal saline/placebo (group P). Intra- and post-operative shivering score, nausea/vomiting score and hemodynamic changes were recorded. Descriptive data was expressed as means and standard deviations (SD). Analysis of variance (ANOVA) and repeated measure analysis were used for continuous parametric variables. Within groups, comparisons were made using the Tukey's post-hoc analysis. Chi-square test ...
Fentanyl Versus Ondansetron for Shivering Prevention in Cesarean Section: A Comparative Study
Background and purpose: The incidence of postoperative shivering (PS) following intrathecal anesthesia is a common complication, with potential negative impacts on patient outcomes. This study aims to evaluate the effectiveness of intrathecal fentanyl versus intravenous ondansetron in preventing post-spinal anesthesia shivering in cesarean section patients. Experimental approach: A randomized controlled trial was conducted from July 2021 to April 2023, involving pregnant women scheduled for cesarean section under intrathecal anesthesia. The participants were divided into three groups: group F received intrathecal fentanyl (15 μg) with spinal anesthesia, while group O received intravenous ondansetron (8 mg) added to the usual saline solution. The control group (group C) received only intravenous fluid before spinal anesthesia and intrathecal bupivacaine without fentanyl. Shivering occurrences were observed and recorded during the procedure. Key results: The incidence of shivering was significantly lower in the fentanyl and ondansetron groups compared to the control group (p=0.0123). Both intrathecal fentanyl and intravenous ondansetron administration showed effectiveness in reducing shivering during spinal anesthesia. Conclusion: The administration of intrathecal fentanyl and intravenous ondansetron significantly reduced the occurrence of shivering during spinal anesthesia in cesarean section patients. This study contributes to advancing knowledge in the field by providing evidence of the preventative effects of these medications on post-spinal anesthesia shivering.