Ketamine and tramadol for the prevention of shivering during spinal anaesthesia

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Introduction: Anaesthesia and surgery promote significant thermal disorder in the human body. Spinal anaesthesia causes lower limb vasodilation and redistribution of body heat from central to the peripheral compartments. Materials and Methods: This was a prospective, randomised, double-blind clinical study to compare the effectiveness of IV ketamine and tramadol in the prevention of shivering associated with spinal anaesthesia. We prospectively studied 150 ASA classification I and II patients between 18 and 70 years old scheduled for any elective surgery performed under spinal anaesthesia. Patients were randomly allocated to receive either prophylactic IV ketamine 0.5 mg/kg (Group K), IV tramadol 0.5 mg/kg (Group T) or normal saline as control (Group P) after intrathecal injection of 0.5% hyperbaric bupivacaine 12.5 mg (2.5 ml) and 25 mcg fentanyl. The frequency and degree of shivering, haemodynamic parameters, core body temperature and side effects of the studied drugs were recorded for the first 30 minutes. Results: The incidence of shivering was 8% in Group K, 16% in Group T and 24% in Group P. This result was statistically significant between Groups K and P. Patients from Group K also exhibited significantly higher mean arterial blood pressure and heart rate at 5 and 15 minutes post intrathecal injection while their mean core temperature was also significantly higher. Side effects such as nausea, vomiting, hallucination, agitation and sweating were comparable between all three groups. Patients from Group K however, had significant higher incidence of behavioural changes (blunted affect or catatonic state) and nystagmus. Conclusion: Prophylactic use of IV ketamine 0.5 mg/kg significantly reduced the frequency and the intensity of perioperative shivering associated with spinal anaesthesia but also exhibited some side effects of the drug. Lower doses of prophylactic ketamine should be studied.

Original languageEnglish
Pages (from-to)193-198
Number of pages6
JournalClinica Terapeutica
Volume165
Issue number4
DOIs
Publication statusPublished - 2014

Fingerprint

Shivering
Tramadol
Spinal Anesthesia
Ketamine
Spinal Injections
Drug-Related Side Effects and Adverse Reactions
Arterial Pressure
Hot Temperature
Sweating
Hallucinations
Bupivacaine
Incidence
Fentanyl
Body Temperature
Human Body
Double-Blind Method
Vasodilation
Nausea
Vomiting
Lower Extremity

Keywords

  • Ketamine
  • Shivering
  • Spinal anaesthesia
  • Tramadol

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Ketamine and tramadol for the prevention of shivering during spinal anaesthesia. / Hidayah, M. N.; Liu, Chian Yong; Su Min, Ooi Joanna.

In: Clinica Terapeutica, Vol. 165, No. 4, 2014, p. 193-198.

Research output: Contribution to journalArticle

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abstract = "Introduction: Anaesthesia and surgery promote significant thermal disorder in the human body. Spinal anaesthesia causes lower limb vasodilation and redistribution of body heat from central to the peripheral compartments. Materials and Methods: This was a prospective, randomised, double-blind clinical study to compare the effectiveness of IV ketamine and tramadol in the prevention of shivering associated with spinal anaesthesia. We prospectively studied 150 ASA classification I and II patients between 18 and 70 years old scheduled for any elective surgery performed under spinal anaesthesia. Patients were randomly allocated to receive either prophylactic IV ketamine 0.5 mg/kg (Group K), IV tramadol 0.5 mg/kg (Group T) or normal saline as control (Group P) after intrathecal injection of 0.5{\%} hyperbaric bupivacaine 12.5 mg (2.5 ml) and 25 mcg fentanyl. The frequency and degree of shivering, haemodynamic parameters, core body temperature and side effects of the studied drugs were recorded for the first 30 minutes. Results: The incidence of shivering was 8{\%} in Group K, 16{\%} in Group T and 24{\%} in Group P. This result was statistically significant between Groups K and P. Patients from Group K also exhibited significantly higher mean arterial blood pressure and heart rate at 5 and 15 minutes post intrathecal injection while their mean core temperature was also significantly higher. Side effects such as nausea, vomiting, hallucination, agitation and sweating were comparable between all three groups. Patients from Group K however, had significant higher incidence of behavioural changes (blunted affect or catatonic state) and nystagmus. Conclusion: Prophylactic use of IV ketamine 0.5 mg/kg significantly reduced the frequency and the intensity of perioperative shivering associated with spinal anaesthesia but also exhibited some side effects of the drug. Lower doses of prophylactic ketamine should be studied.",
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