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PREVENTION OF POST-ANAESTHETIC SHIVERING UNDER SUB-ARACHNOID BLOCK FOR CAESAREAN SECTION: A RANDOMISED, CONTROLLED STUDY COMPARING TRAMADOL VERSUS ONDANSETRON
ABSTRACT
Shivering is a frequent, undesirable peri-operative event in patients undergoing caesarean
delivery under spinal anaesthesia. Many drugs have been tried, with varying success rates, in preventing
post-spinal shivering.
This was a prospective, randomized, placebo-controlled study comparing the effectiveness of
single dose intravenous tramadol versus ondansetron in preventing shivering among women undergoing
caesarean section under spinal anaesthesia. One hundred American Society of Anesthesiologists’ (ASA)
class I-II patients undergoing elective or emergency caesarean section under spinal anaesthesia were
randomly allocated into three groups: control group (group S, n=33), tramadol group (group T, n=33) or
ondansetron group (group O, n=34).
Immediately after establishing spinal anaesthesia, patients in group S were given 4ml of 0.9%
saline intravenously, patients in group T were given 50mg of tramadol (diluted to a volume of 4ml with
sterile water for injection) intravenously while patients in group O were given 4mg of ondansetron
(diluted to a volume of 4ml with sterile water for injection) intravenously. The patients were monitored
and records of shivering, vital signs and adverse effects of the drugs were taken. Neonatal APGAR
scores were also recorded.
Shivering occurred in a significantly less number of patients in group O than group T (5.9% versus 39.4%, p=0.001). There was no statistical difference in the incidence of shivering between groups T and S (39.4% versus 48.5%, p=0.460). Core body temperature was better preserved in group T than groups S and O. Cumulative ephedrine consumption was lowest in group O (42mg) compared to group T (54mg) or group S (102mg). There was no record of nausea and vomiting in group O as against 18.2% and 6.1% in groups T and S respectively. Less number of patients had sedation in group O (6, 12.6%) than group T (11, 33.3%). The newborn APGAR scores were similar across the three groups. In conclusion, this study has demonstrated the superiority of ondansetron over tramadol in
preventing post-anaesthetic shivering in women undergoing caesarean section under spinal anaesthesia.
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