Intrathecal Versus Intravenous Tramadol in prevention of Post-spinal anaesthesia Shivering

Spinal anesthesia (SA) is a very common technique used by anesthesiologist (1). It involves the injection of a local anaethetic into the subarachnoid space to anaesthetize the lower part of the body. Shivering is a common complication following SA. The incidence varies from 40% to 70%.[1] It is a spontaneous, involuntary and oscillatory fasciculations, or tremor-like hyperactivity of the skeletal muscles.[2] This makes it distressing for both the patient and the surgeon. It increases metabolic rate, oxygen consumption, CO2 production, heart rate, and blood pressure.[1,2] These increase the cardiac workload leading to wound pain, delay wound healing, and prolong hospital stay. It also interferes with the perioperative vital monitoring and increases intraocular and intracranial pressures.[1] All these sequelae coupled with the high incidence of postopearative shivering makes its prophylaxis imperative.Prophylaxis with intravenous (IV) tramadol produces a dose-dependent reduction in the incidence of postanesthesia shivering.[3] Tramadol is a commonly used intrathecal (IT) adjuvant. It prolongs the duration of sensory and motor block, and improves postoperative analgesia.Few studies assess antishivering efficacy of IT tramadol .[2] So the present study aims to compare the antishivering effect of both routes of tramadol (IT and IV) in patients undergoing lower limb orthopedic surgeries under SA. references:1. De Witte J, et al. Perioperative shivering:Physiology and pharmacology.Anesthesiology.2002;96:467–84 2. Prasad RB, et al. Effectiveness of addition of intrathecal tramadol with hyperbaric bupivacaine in prevention of shivering in parturients undergoing caesarean section under spinal anaesthesia: A randomized placebo-controlled study. Karnataka Anaesth J. 2015;1:123–7. 3. Mohta M, et al. Tramadol for prevention of postanaesthetic shivering: A randomised double-blind comparison with pethidine. Anaesthesia. 2009;64:141–6.