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EVALUATION OF THE EFFICACY OF TRAMADOL IN THE PREVENTION OF POST SPINAL ANAESTHESIA SHIVERING IN CAESAREAN DELIVERIES
ABSTRACT
Shivering associated with subarachnoid blocks in obstetric patients is a cause of discomfort in this group of patients. Tramadol , a synthetic weak opioid that acts centrally at the mu receptors has been found to be effective in the treatment of shivering after general anaesthesia.
The aim of this study was to investigate whether intravenous 1mg/kg tramadol administered immediately after the delivery of the newborn to parturients undergoing spinal anaesthesia for Caesarean deliveries would prevent shivering.
In a double blinded clinical trial, one hundred (100) healthy obstetric patients who were booked for elective or emergency Caesarean section under spinal anaesthesia were randomised into two groups. Immediately after the delivery of the foetus, fifty (50) patients received 1mg/kg tramadol diluted to 2ml with sterile water and fifty (50) patients received 2ml of sterile water.
The researcher who was blinded to the study solutions injected, recorded the incidence and intensity of shivering, level of sedation and other parameters which included blood pressure, pulse rate, oxygen saturation and temperature.
The incidence of shivering was significantly lower in patients who received tramadol than those who received placebo 18% versus 72% (P < 0.001) In the placebo group 17 patients(34%) and 19(38%) had grade one shivering and grade two shivering respectively as compared to 7 patients(14%) with grade one shivering and 2 patients (4%) with grade two shivering in the study group. The severity of shivering was significantly higher in the placebo group with P value 0f 0.0001. There were no significant differences in the vital signs( mean arterial pressure, heart rate, oxygen saturation and axillary temperature ) of the two groups. There was no difference in the sedation scores of the two groups ,
and in the incidence of pharmacological side effects like pruritus, dizziness and respiratory depression, although nausea and vomiting was significantly higher in the study group with P values of 0.004 for nausea and 0.005 for vomiting.
The results of this study revealed that intravenous tramadol 1mg/kg is effective in the prevention of shivering following spinal anaesthesia for Caesarean section but its use is associated with more nausea and vomiting.
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