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49 Comparison of anti-shivering effect of intravenous versus intrathecal tramadol in patients undergoing lower limb surgery under spinal anaesthesia
  1. EMohamed Abd El Azeem,
  2. M Abdel-Ghaffar and
  3. SA Al-Touny
  1. Suez Canal University, Ismailia, Egypt


Background and Aims Shivering occurs in 40–60 percent of patients under spinal anaesthesia. (1)

Prophylaxis with intravenous tramadol produces a dose-dependent reduction in the incidence of shivering. (2) Tramadol is a common intrathecal adjuvant, safely used in a dose up to 20 mg. Few studies tested the anti-shivering efficacy of intrathecal tramadol. (3,4) However, no study compared the anti-shivering effect of intravenous versus intrathecal tramadol. Therefore, we conceptualized this trial to compare the anti-shivering effect of intravenous versus intrathecal tramadol.

Methods This study was a randomized, double-blinded clinical trial that included 86 ASA I & II patients divided into two equal groups. It included patients aged 18–65 years who undergone lower limb orthopedic surgeries; that lasted less than two hours under spinal anesthesia. Our institutional ethical committee approved the protocol and was registered at PACTR (trial ID: PACTR202007664590852). Patients were allocated randomly into control (IV) group and interventional (IT) group. The Control group received intrathecal 15 mg bupivacaine then IV tramadol 25 mg in 5 ml normal saline. The interventional group received 20 mg tramadol added to15 mg bupivacaine intrathecally then IV 5 ml normal saline. The primary outcome was the incidence of intra-operative shivering which was assessed by Bedside Shivering Assessment Scale. (5)Patients who developed intraoperative shivering were given 25 mg IV tramadol.

Results Shivering was observed in 8(18.6%) patients in intravenous group compared to 2(4.6%) patients in intrathecal group (P-value of 0.047).

Postoperative nausea occurred in 12(27.9%) patients in intravenous group versus 4(9.3%) patients in intrathecal group with a p-value of 0.026.

Abstract 49 Table 1

Patient characteristics of the two groups

Abstract 49 Table 2

Post-operative complications among the two groups

Conclusions Intra-thecal tramadol prevents post-spinal shivering without complications.

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