Efficacy of Tramadol and Fentanyl when used Intrathecally for Prevention of Shivering in Endoscopic Urosurgical Cases- A Randomised Control TrialCorrespondence Address :
Leena Shibu Paulose,
301, Nakshatram, Sector No. 43/3A/1, Near Devang Hostel, Sharada Colony, Pimple Nilakh, Pune-411027, Maharastra, India.
Introduction: Shivering is an undesired complication seen perioperatively with incidence of 40 to 70% under spinal anaesthesia. This further increases in patients undergoing endoscopic urosurgical procedures where huge amount of cold irrigating solution is used.
Aim: To compare the anti-shivering effect of intrathecal tramadol with intrathecal fentanyl given as an additive in spinal anaesthesia in endoscopic urosurgical cases.
Materials and Methods: It was a randomised control study. Total 105 patients of American Society of Anaesthesiologists (ASA) grade I and II posted for various endoscopic urosurgeries were included in the study and divided into three groups by computerised randomisation. Group T received injection bupivacaine 0.5% heavy 15 to 20 mg (3 to 4 mL) plus 20 mg (0.4 mL) tramadol in spinal anaesthesia, Group F received injection bupivacaine 0.5% heavy 15 to 20 mg (3 to 4 mL) plus 25 microgram (0.5 mL) fentanyl in spinal anaesthesia and Group C received injection bupivacaine 0.5% heavy 15 to 20 mg (3 to 4 mL) plus 0.5 mL normal saline. Incidence and grade of shivering was recorded in each group. The data was analysed using statistical package SPSS version 21.0. Mean and SD were calculated for the quantitative variables. Analysis of variance test was used to compare the means of three groups with respect to each of the parameters.
Results: Significant difference was observed among three groups in respect of incidence of shivering intraoperatively and postoperatively both. Least incidence of shivering was observed in tramadol intraoperatively with a p-value <0.05. Also, tramadol group had least shivering postoperatively with a p-value <0.05. Also, the grade of shivering in control group was significantly higher (p-value <0.05) than that of both group F and group T. There was no statistically significant difference among the three groups in respect of sedative score, itching, nausea, vomiting and respiratory depression (p-value >0.05).
Conclusion: Intrathecal tramadol is more effective than intrathecal fentanyl in prevention of shivering in patients undergoing endoscopic urological surgeries and also has low side effect profile.
Anti-shivering effect, Hypothermia, Spinal adjuvant, Spinal anaesthesia
Date of Submission: Jul 06, 2020
Date of Peer Review: Aug 03, 2020
Date of Acceptance: Oct 19, 2020
Date of Publishing: Dec 15, 2020
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. NA
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