Premedication with oral tramadol reduces severity of postoperative shivering after general anesthesia

Authors

Anaesthesiology and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

Abstract

Background: Postanesthetic shivering (PAS) is an accompanying part of general anesthesia with different unpleasant and stressful complications. Considering the importance of proper prevention of PAS in order to reduce its related adverse complications in patients undergoing surgery, in this study, we investigated the effect of orally administrated tramadol in the prevention of this common complication of general anesthesia.
Materials and Methods: In this prospective randomized double-blind clinical trial, 80 ASA I and II patients aged 15-70 years, scheduled for elective surgery under general anesthesia, were randomized to intervention (oral tramadol 50 mg) and placebo groups. PAS was evaluated during surgery and in the recovery room, and compared in the two study groups.
Results: PAS was seen in 5 patients (12.5%) in the intervention group and 10 patients (25%) in the placebo group (P = 0.12). The prevalence of grade III and IV shivering was 7.5% (3/40) and 25% (10/40) in tramadol and placebo groups, respectively (P = 0.03).
Conclusion: The overall prevalence of PAS was not significantly different in the two study groups, but the higher grades of shivering which needed treatment were significantly lower in the tramadol group than in the placebo, and those patients who received tramadol experienced milder form of shivering. It is suggested that higher doses of tramadol would have better anti-shivering as well as analgesic effects. Studying different doses of tramadol would be helpful in this regard.

Keywords

1. Asl ME, Isazadefar K, Mohammadian A, Khoshbaten M. Ondansetron and meperidine prevent postoperative shivering after general anesthesia. Middle East J Anesthesiol 2011;21:67-70.  Back to cited text no. 1
[PUBMED]    
2. Gecaj-Gashi A, Hashimi M, Sada F, Salihu S, Terziqi H. Prophylactic ketamine reduces incidence of postanaesthetic shivering. Niger J Med 2010;19:267-70.  Back to cited text no. 2
[PUBMED]    
3. Sessler DI. Temperature monitoring. In: Miller RD, editor. Miller's anesthesia. 6 th ed. Philadelphia: Churchill Livingstone; 2005. p. 1571-97.  Back to cited text no. 3
    
4. Bhattacharya PK, Bhattacharya L, Jain RK, Agarwal RC. Post Anesthesia Shivering: A review. Indian J Anaesth 2003;47:88-93.  Back to cited text no. 4
  Medknow Journal  
5. Shrestha AB. Comparative study on effectiveness of doxapram and pethidine for postanaesthetic shivering. J Nepal Med Assoc 2009;48:116-20.  Back to cited text no. 5
    
6. Alfonsi P. Postanaesthetic shivering: Epidemiology, pathophysiology, and approaches to prevention and management. Minerva Anestesiol 2003;69:438-42. Review.  Back to cited text no. 6
    
7. Mahamood MA, Zweifler RM. Progress in shivering control. J Neurol Sci 2007;261:47-54.  Back to cited text no. 7
    
8. Roy JD, Girard M, Drolet P. Intrathecal meperidine decreases shivering during cesarean delivery under spinal anesthesia. Anesth Analg 2004;98:230-4.  Back to cited text no. 8
    
9. Techanivate A, Dusitkasem S, Anuwattanavit C. Dexmedetomidine compare with fentanyl for postoperative analgesia in outpatient gynecologic laparoscopy: A randomized controlled trial. J Med Assoc Thai 2012;95:383-90.  Back to cited text no. 9
    
10. le Roux PJ, Coetzee JF. Tramadol today. Curr Opin Anaesthesiol 2000;13:457-61.  Back to cited text no. 10
    
11. Mathews S, Al Mulla A, Varghese PK, Radim K, Mumtaz S. Postanaesthetic shivering-a new look at tramadol. Anaesthesia 2002;57:394-8.  Back to cited text no. 11
    
12. Trekova NA, Buniation AA, Zolicheva NI. Tramadol hydrochloride in the treatment of postoperative shivering. Anesteziol Reanimatol 2004:86-9.  Back to cited text no. 12
    
13. Grond S, Sablotzki A. Clinical pharmacology of tramadol. Clin Pharmacokinet 2004;43:879-923.  Back to cited text no. 13
    
14. Drugs @ FDA page. U.S. Food and drug administration web site. Available from: http://www.fda.gov/Drugs/default.htm.[Last accessed on 2011 May 1]  Back to cited text no. 14
    
15. Kaye K, Theaker N. New South wales therapeutic assessment group. TRAMADOL: A position statement of the NSW therapeutic assessment group Inc. Sydney: NSW TAG; 2001.  Back to cited text no. 15
    
16. Crossly AW, Mahajan RP. The intensity of postoperative shivering is unrelated to axillary temperature. Anaesthesia 1994;49:205-7.  Back to cited text no. 16
    
17. Javaherforoosh F, Akhondzadeh R, Aein KB, Olapour A, Samimi M. Effects of Tramadol on shivering post spinal anesthesia in elective cesarean section. Pak J Med Sci 2009;25:12-7.  Back to cited text no. 17
    
18. Raffa RB, Nayak RK, Minn FL. The mechanism(s) of action and pharmacokinetics of tramadol hydrochloride. Rev Contemp Pharmacother 1995;6:485-97.  Back to cited text no. 18
    
19. 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;64:141-6.  Back to cited text no. 19
    
20. 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;25:468-72.  Back to cited text no. 20
    
21. De Witte J, Deloof T, De Veylder J, Housemans PR. Tramadol in the treatment of postanaesthetic shivering. Acta Anaesthesiol Scand 1997;41:506-10.  Back to cited text no. 21
    
22. Atashkhoyi S, Niazi M, Iranpour A. Effect of tramadol adiministratian previous to induction of general anesthesia on prevention of postoperative shivering. J Zanjan Univ Med Sci Health Serv 2008;16:29-36.  Back to cited text no. 22