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Hyperbaric Bupivacaine alone Versus Hyperbaric Bupivacaine and Tramadol Combination for Shivering in Spinal Anaesthesia Surgeries

Background: Shivering is a normal physiologic protective mechanism of the body, which in response to core hypothermia, increases metabolic heat production that results in involuntary, oscillatory muscle activity. Spinal anesthesia promotes redistribution of body heat from central to the peripheral compartments. After spinal anesthesia shivering occurs in 40-60% of patients. Tramadol is synthetic codeine analog that is weak Mu opioid receptor agonist. It also has effect of norepinephrine and serotonin reuptake inhibition. It proves to be more effective in prevention and treatment of shivering and it also has less side effects then Mu opioid agonists. Objective: To compare the outcome of hyperbaric bupivacaine alone, with combination of hyperbaric bupivacaine and tramadol to prevent frequency of shivering in spinal anaesthesia. Study Design: Randomized clinical trial study. Place and Duration of Study: Department of Anaesthesiology & Gynaecology, POF Hospital, Wah Cantt, HIT Taxilla and Izzat Ali Shah Hospital, Wah Cantt from 1st December 2018 to 31st December 2020. Methodology: One hundred and 100 patients were included and divided into two equal groups. Patients in Group A received 2ml of 0.75% hyperbaric bupivacaine (15mg) and group B received 2ml of 0.75% hyperbaric bupivacaine (15mg) and preservative free tramadol (10mg, 0.2ml) in spinal anesthesia. Results: There were 13 (26%) female patients in group A and 37 (74%) male patients. In group B there were 35 (70%) male patients and 15 (30%) female patients. The mean age in group A was 42±8.05 years and 42±8.02 years in group B. Thirty two (64%) in whom shivering was present and 18 (36%) no shivering accrued in group A while in group B, 11 (22%) in whom shivering was present and 39 (78%) no shivering accrued (P<0.05). Conclusion: Post-anesthetic shivering appeared to be present in post spinal anaesthesia patients very commonly. Administration of tramadol has proved to significantly reduce incidence of shivering. More studies still need to be done on tramadol to confirm its efficacy in preveting and stopping shivering without systemic effects on patients. Keywords: Spinal anaesthesia, Bupivacaine, Tramadol, Shivering