The effects of preemptive tramadol and dexmedetomidine on shivering during arthroscopy

Semsettin Bozgeyik, Ayse Mizrak, Ertuğrul Kılıç, Fatih Yendi, Berna Kaya Ugur, Semsettin Bozgeyik, Ayse Mizrak, Ertuğrul Kılıç, Fatih Yendi, Berna Kaya Ugur

Abstract

Background: Shivering, the rate of which in regional anesthesia is 39% is an undesired complication seen postoperatively.

Aims: This study aims to compare the ability of preventing the shivering of preemptive tramadol and dexmedetomidine during the spinal anesthesia (SA).

Methods: A total of 90 patients with American Society of Anesthesiologists physical status I-II, aged 18-60 years and undergoing elective arthroscopic surgery with SA were divided into three groups randomly. After spinal block, 100 mg tramadol in 100 ml saline was applied in group T- (n = 30) and 0.5 μg/kg dexmedetomidine in 100 ml saline was applied in group D- (n = 30) and 100 ml saline was administered in group P- (n = 30) in 10 min. The hemodynamics, oxygen saturation, tympanic temperature, shivering and sedation scores were evaluated and recorded intraoperatively and 45 min after a postoperative period.

Results: In group T and D, shivering scores were significantly lower when compared with group P in the intraoperative 20(th) min (P = 0.01). Sedation scores in group D were significantly higher than the baseline values (P = 0.03) and values in group T and P (P = 0.04).

Conclusions: Preemptive tramadol and dexmedetomidine are effective in preventing the shivering under SA. In addition, dexmedetomidine was superior in increasing the level of sedation which is sufficient to prevent the anxiety without any adverse effects.

Keywords: Arthroscopic surgery; dexmedetomine; shivering; spinal anesthesia; tramadol.

Conflict of interest statement

Conflict of Interest: None declared

Figures

Figure 1
Figure 1
The Intraoperative Tympanic Temperature of the Groups
Figure 2
Figure 2
The Postoperative Tympanic Temperature of the Groups

References

    1. Buggy DJ, Crossley AW. Thermoregulation, mild perioperative hypothermia and postanesthetic shivering. Br J Anaesth. 2000;84:615–28.
    1. Alfonsi P. Postanesthetic shivering: Epidemiology, pathophysiology, and approaches to prevention and management. Drugs. 2001;61:2193–205.
    1. Chan AM, Ng KF, Tong EW, Jan GS. Control of shivering under regional anesthesia in obstetric patients with tramadol. Canadian journal of anesthesia = Journal canadien d’anesthesie. 1999;46:253–8.
    1. Emerick TH, Ozaki M, Sessler DI, Walters K, Schroeder M. Epidural anesthesia increases apparent leg temperature and decreases the shivering threshold. Anesthesiology. 1994;81:289–98.
    1. Sessler DI. Complications and treatment of mild hypothermia. Anesthesiology. 2001;95:531–43.
    1. Buggy D, Higgins P, Moran C, O’Donovan F, McCarroll M. Clonidine at induction reduces shivering after general anesthesia. Canadian journal of anesthesia = Journal canadien d’anesthesie. 1997;44:263–7.
    1. Talke P, Tayefeh F, Sessler DI, Jeffrey R, Noursalehi M, Richardson C. Dexmedetomidine does not alter the sweating threshold, but comparably and linearly decreases the vasoconstriction and shivering thresholds. Anesthesiology. 1997;87:835–41.
    1. Jalonen J, Hynynen M, Kuitunen A, Heikkila H, Perttila J, Salmenpera M, et al. Dexmedetomidine as an anesthetic adjunct in coronary artery bypass grafting. Anesthesiology. 1997;86:331–45.
    1. Mathews S, Al Mulla A, Varghese PK, Radim K, Mumtaz S. Postanesthetic shivering – a new look at tramadol. Anesthesia. 2002;57:394–8.
    1. Tsai YC, Chu KS. A comparison of tramadol, amitriptyline, and meperidine for postepidural anesthetic shivering in parturients. Anesthesia and analgesia. 2001;93:1288–92.
    1. Ramsay MA, Savege TM, Simpson BR, Goodwin R. Controlled sedation with alphaxalone-alphadolone. British medical journal. 1974;2:656–9.
    1. Frank SM, El-Rahmany HK, Cattaneo CG, Barnes RA. Predictors of hypothermia during spinal anesthesia. Anesthesiology. 2000;92:1330–4.
    1. De Witte JL, Kim JS, Sessler DI, Bastanmehr H, Bjorksten AR. Tramadol reduces the sweating, vasoconstriction, and shivering thresholds. Anesthesia and analgesia. 1998;87:173–9.
    1. Piper SN, Maleck WH, Boldt J, Suttner SW, Schmidt CC, Reich DG. A comparison of urapidil, clonidine, meperidine and placebo in preventing postanesthetic shivering. Anesthesia and analgesia. 2000;90:954–7.
    1. Vanderstappen I, Vandermeersch E, Vanacker B, Mattheussen M, Herijgers P, Van Aken H. The effect of prophylactic clonidine on postoperative shivering. A large prospective double-blind study. Anaesthesia. 1996;51:351–5.
    1. Wrench IJ, Singh P, Dennis AR, Mahajan RP, Crossley AW. The minimum effective doses of pethidine and doxapram in the treatment of post-anesthetic shivering. Anesthesia. 1997;52:32–6.
    1. Bicer C, Esmaoglu A, Akin A, Boyaci A. Dexmedetomidine and meperidine prevent postanesthetic shivering. European journal of anaesthesiology. 2006;23:149–53.
    1. Piper SN, Suttner SW, Schmidt CC, Maleck WH, Kumle B, Bold J. Nefopam and clonidine in the prevention of postanaesthetic shivering. Anaesthesia. 1999;54:695–9.
    1. Piper SN, Rohm KD, Suttner SW, Maleck WH, Kranke P, Boldt J. A comparison of nefopam and clonidine for the prevention of postanaesthetic shivering: a comparative, double-blind and placebo-controlled dose-ranging study. Anaesthesia. 2004;59:559–64.
    1. Elvan EG, Oc B, Uzun S, Karabulut E, Coskun F, Aypar Ü. Dexmedetomidine and postoperative shivering in patients undergoing elective abdominal hysterectomy. European journal of anaesthesiology. 2008;25:357–64.
    1. Blaine Easley R, Brady KM, Tobias JD. Dexmedetomidine for the treatment of postanesthesia shivering in children. Paediatric anesthesia. 2007;17:341–6.
    1. De Witte J, Rietman GW, Vandenbroucke G, Deloof T. Post-operative effects of tramadol administered at wound closure. European journal of anaesthesiology. 1998;15:190–195.
    1. Eggers KA, Power I. Tramadol. British journal of anesthesia. 1995;74:247–9.
    1. 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 journal of medical sciences. 1994;10:632–9.
    1. Venn M, Newman J, Grounds M. A phase II study to evaluate the efficacy of dexmedetomidine for sedation in the medical intensive care unit. Intensive care medicine. 2003;29:201–7.
    1. Venn RM, Grounds RM. Comparison between dexmedetomidine and propofol for sedation in the intensive care unit: Patient and clinician perceptions. British journal of anesthesia. 2001;87:684–90.
    1. Mohta M, Kumari N, Tyagi A, Sethi AK, Agarwa D, Singh M. Tramadol for prevention of postanaesthetic shivering: a randomised double-blind comparison with pethidine. Anaesthesia. 2009;64:141–6.
    1. Jaakola ML. Dexmedetomidine premedication before intravenous regional anesthesia in minor outpatient hand surgery. Journal of clinical anesthesia. 1994;6:204–11.
    1. De Witte J, Deloof T, de Veylder J, Housmans PR. Tramadol in the treatment of postanesthetic shivering. Acta anaesthesiologica Scandinavica. 1997;41:506–10.

Source: PubMed

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