49 Comparison of anti-shivering effect of intravenous versus intrathecal tramadol in patients undergoing lower limb surgery under spinal anaesthesia

Background and Aims Shivering occurs in 40–60 percent of patients under spinal anaesthesia. (1) Prophylaxis with intravenous tramadol produces a dose-dependent reduction in the incidence of shivering. (2) Tramadol is a common intrathecal adjuvant, safely used in a dose up to 20 mg. Few studies tested the anti-shivering efficacy of intrathecal tramadol. (3,4) However, no study compared the anti-shivering effect of intravenous versus intrathecal tramadol. Therefore, we conceptualized this trial to compare the anti-shivering effect of intravenous versus intrathecal tramadol. Methods This study was a randomized, double-blinded clinical trial that included 86 ASA I & II patients divided into two equal groups. It included patients aged 18–65 years who undergone lower limb orthopedic surgeries; that lasted less than two hours under spinal anesthesia. Our institutional ethical committee approved the protocol and was registered at PACTR (trial ID: PACTR202007664590852). Patients were allocated randomly into control (IV) group and interventional (IT) group. The Control group received intrathecal 15 mg bupivacaine then IV tramadol 25 mg in 5 ml normal saline. The interventional group received 20 mg tramadol added to15 mg bupivacaine intrathecally then IV 5 ml normal saline. The primary outcome was the incidence of intra-operative shivering which was assessed by Bedside Shivering Assessment Scale. (5)Patients who developed intraoperative shivering were given 25 mg IV tramadol. Results Shivering was observed in 8(18.6%) patients in intravenous group compared to 2(4.6%) patients in intrathecal group (P-value of 0.047). Postoperative nausea occurred in 12(27.9%) patients in intravenous group versus 4(9.3%) patients in intrathecal group with a p-value of 0.026. Conclusions Intra-thecal tramadol prevents post-spinal shivering without complications.