Addition of low dose ketamine to tramadol for prevention of post–anesthetic shivering: a comparative study
Abstract
Background and objectives: Post-anesthetic shivering (PAS) is a common complication following general and regional anesthesia. It is important to identify centrally-acting analgesic drugs that can effectively prevent and treat shivering with fewer side effects other than opioid agonists. Our study compared the effect of addition of low dose ketamine to tramadol for the prevention of shivering under spinal anesthesia.
Methodology: This randomized controlled trial study was conducted for six months, from May 01, 2016 to October 10, 2016, at Department of Anesthesiology, Surgical ICU and Pain Management, Civil Hospital Karachi, Pakistan.
All patients with ages between 18 to 50 y, of both genders, American Society of Anesthesiologist physical status I and II, scheduled for inguinal hernia surgeries were included. The patients were randomly allocated to Group T (inj. tramadol 0.5 mg/kg) and Group KT (inj. ketamine 0.25 mg/kg plus Tramadol 0.25 mg/kg). Shivering was graded 1–5, and was labeled as positive if the grade was 2–5. Time to shivering was noted from the administration of spinal anesthesia to onset of shivering. Perioperative complications such as nausea, vomiting, hypotension or bradycardia, were recorded
Results: The study included 190 patients, with 95 in each group. Demographic characteristics, ASA classification, and perioperative vitals of both groups were comparable (p > 0.05). The frequency of shivering in patients of Group KT was lower as compared to Group T [65(68.4%) vs. 81(85.2%); (p < 0.05)] respectively. Group T had earlier onset of shivering than Group KT [24.01 ± 1.9 min vs. 33.1 ± 2.8 min; (p < 0.05) respectively. Perioperative complication such as nausea, vomiting, hypotension and bradycardia were also less in the Group KT.
Conclusion: The prophylactic use of low-dose ketamine plus tramadol for the prevention of shivering is better than tramadol alone under spinal anesthesia.
Abbreviations: PAS Post-anesthetic shivering; NMDA N-methyl-d-aspartate; bmi Body mass index
Key words: Intravenous; Tramadol; Ketamine; Shivering, Postoperative; Anaesthesia, Spinal
Citation: Baig MS, Naz A, Kumar V, Khan SS, Javed S. Addition of low dose ketamine to tramadol for prevention of post–anesthetic shivering: a comparative study. Anaesth. pain intensive care 2021;25(5):596–601;
DOI: 10.35975/apic.v25i5.1626
Received: June 02, 2021, Reviewed: June 22, 2021, Accepted: June 27, 2021
