Randomized Double-Blinded Comparative Study of Intravenous Nalbuphine and Tramadol for the Treatment of Postspinal Anesthesia Shivering

Deepak Kumar Nirala; Jay Prakash; Barun Ram; Vishwanath Kumar; Pradip Kumar Bhattacharya; Shio Priye

doi:10.4103/aer.AER_95_20

Randomized Double-Blinded Comparative Study of Intravenous Nalbuphine and Tramadol for the Treatment of Postspinal Anesthesia Shivering

Anesth Essays Res. 2020 Jul-Sep;14(3):510-514. doi: 10.4103/aer.AER_95_20. Epub 2021 Mar 22.

Authors

Deepak Kumar Nirala¹, Jay Prakash¹, Barun Ram², Vishwanath Kumar³, Pradip Kumar Bhattacharya¹, Shio Priye⁴

Affiliations

¹ Department of Critical Care Medicine, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India.
² Department of Critical Care (Trauma), Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India.
³ Department of Trauma Anaesthesia, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India.
⁴ Department of Superspeciality Anaesthesia, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India.

Abstract

Context: Shivering is one of the most commonly recognized complications of the central neuraxial blockade. For optimal perioperative care, control of postspinal anesthesia shivering is essential.

Aims: The present study designed to compare the clinical efficacy, hemodynamic parameters, and side effects of nalbuphine and tramadol for control of postspinal anesthesia shivering.

Settings and design: This was a prospective, randomized, double-blind study.

Materials and methods: This study was conducted on 90 American Society of Anesthesiologists Physical Status I and II patients of either gender, aged between 18 and 60 years, who subsequently developed shivering grade 3 or 4, scheduled for different surgical procedures under spinal anesthesia. The patients were randomized into two groups of 45 patients each to receive either nalbuphine 0.06 mg.kg^-1 (Group N) or tramadol 1 mg.kg^-1 (Group T). Grade of shivering, onset of shivering, time interval for cessation of shivering, response rate at 5 and 30 min, rescue dose, hemodynamic parameters, and side effects were observed at scheduled intervals.

Statistical analysis used: Independent t-test and Chi-square/Fisher's exact test were used to analyze the data.

Results: The time taken for cessation of shivering was significantly less with nalbuphine in comparison with tramadol (P < 0.05). It was observed that the response time at 5 and 30 min and rescue dose requirement for control of shivering were not much difference (P > 0.05).

Conclusions: Both nalbuphine and tramadol are effective; however, the time taken for cessation of shivering is significantly less with nalbuphine when compared to tramadol. Furthermore, tramadol causes significantly more nausea and vomiting; however, nalbuphine causes significantly more sedation.

Keywords: Nalbuphine; postspinal anesthesia shivering; tramadol.