A Comparative Study of the Effect of IV Ketamine with IV Tramadol on Intraoperative Shivering in Patients Undergoing Caesearean Section Under Spinal Anaesthesia: Randomized Clinical Trial

Abstract

BACKGROUND AND OBJECTIVE ABSTRACT Intraoperative shivering is one of the most common complications of spinal anaesthesia. It is an unpleasant and physiological stressful experience. It occurs in 5 to 65 % of patients recovering from anaesthesia. The main objective of the study was to compare the effectiveness of 0.5 mg/kg IV Ketamine with 0.5 mg/kg of IV Tramadol to reduce the intraoperative shivering in patients undergoing Caesearean section under spinal anaesthesia. METHODLOGY The present study was conducted in the department of Anaesthesiology, KLES Hospital and MRC, Belgaum during the period of Dec 2008 to 2009. After obtaining an approval by the ethics committee, patients who gave written and informed consent to participate in this study were included. Only ASA I or ASA II consenting parturients who subsequently developed intraoperative shivering were included. They were randomly allocated into either of the two groups– Group Ketamine or Group Tramadol by computer generated allocation. Intraoperative tympanic membrane temperature was recorded from start of the procedure and then after every 10 minutes interval. Patient was observed for shivering and graded on the following scale - 0- No shivering. 1- Mild fasciculation. 2- Tremors in one group of muscles / one part of the body. 3 - Tremors in more than one group / whole body. X After the onset of shivering IV Ketamine 0.5 mg/kg or IV Tramadol 0.5 mg/kg were given. Antishivering effect of the drug was noted on a 2 minute time interval till 10 minutes. In case of no response for 10 minutes rescue drug Pethidine 0.5 mg/kg IV was given. Patient was noted for any side effects. CONCLUSION AND INTERPRETATION The number of patients who stopped shivering ( completely improved ) within 10 minutes of receiving Ketamine were 28 out of 35 ( 80 % ) , while in Tramadol group only 19 out of 35 patients ( 54.2 % ) improved completely within 10 minutes. Mean grade of shivering at intervals of 2 minutes after injecting the drug was significantly lower in Ketamine group, in which grade of shivering dropped from grade 2 to 0 by 6 minutes, while in Tramadol group it dropped to grade 1 by 10 minutes. The antishivering effect in both the groups commenced by 2 minutes, however peak anti shivering effect of Ketamine was observed at 4 minutes while peak anti shivering of Tramadol was observed at 10 minutes. In conclusion, Ketamine 0.5 mg / kg IV and Tramadol 0.5 mg / kg IV are useful drugs in controlling shivering in patients undergoing caesarean section under spinal anesthesia. Ketamine was found to be more effective antishivering drug and can be recommended to control shivering under regional anesthesia in patients undergoing caesarean section, keeping in mind the hallucination and sedation as side effects.