In most operating and recovery rooms, shivering is controlled by the use of humidifiers, warming blankets, and inhalation of humidified heated oxygen. However, pharmacological control is an effective alternate treatment modality. This randomized, double-blind trial, conducted in 30 ASA Grade I or 2 patients, was designed to explore the efficacy of tramadol and pethidine in the treatment of post-anaesthetic shivering.
Tramadol is an inhibitor of the re-uptake of serotonin (5-hydroxytryptamine) and norepinephrine in the spinal cord. This facilitates 5-hydroxytryptamine release, which influences thermoregulatory control. We compared the efficacy of tramadol with that of pethidine, presently a widely used drug for the control of shivering. Patients received either tramadol 1mg/kg or pethidine 0.5 mg/kg intravenously and the grade of shivering, pulse rate, blood pressure and respiratory rate were observed every 10 minutes after injection for one hour. Shivering was significantly more likely to have ceased in the tramadol group (12 of 15 versus 4 of 15 cases, P<0.05) at 10 minutes after drug administration and this control was better sustained. No patients receiving tramadol had a recurrence of shivering. It is concluded that intravenous tramadol 1 mg/kg is more effective for the treatment of postoperative shivering than pethidine 0.5 mg/kg.
HoldcroftA., HallG.M.Heat loss during anaesthesia.Br J Anaesth1978; 50: 157–154.
2.
PaucaA.L., SavageR.T., SimpsonS., RoyR.C.Effect of pethidine, fentanyl and morphine on post-operative shivering in man.Acta Anaesthesiol Scand1984; 28: 138–143.
3.
PflugA.E., AasheimG.M., FosterC., MartinR.W.Prevention of post anaesthesia shivering.Can Anaesth Soc J1978; 25: 43–49.
4.
SinghP., DimitriouV., MahajanR.P.. Double blind comparison between doxapram and pethidine in treatment of post anaesthetic shivering.Br J Anaesth1993; 71: 685–688.
5.
KurzM., BelaniKG., SesslerD.I.. Naloxone, meperidine and shivering.Anesthesiology1993; 79: 1193–1201.
6.
WrenchI.J., SinghP., DennisA.R.. The minimum effective doses of pethidine and doxapram in the treatment of post anaesthetic shivering.Anaesthesia1997; 52: 32–36.
7.
MonsoA., RiudeubasJ., BarbalF.. A randomized, double blind, placebo controlled trial comparing pethidine to metamizol for treatment of post-anaesthetic shivering.Br J Clin Pharmacol1996; 42: 307–311.
8.
PaucaA.L., SavageR.T., SimpsonS., RoyR.C.Effect of pethidine, fentanyl and morphine on post-operative shivering in man.Acta Anaesthesiol Scand1984; 28: 138–143.
9.
WrenchI.J., CavillG., WardJ.E.H., CrossleyA.W.A.Comparison between alfentanil, pethidine and placebo in the treatment of postanaesthetic shivering.Br J Anaesth1997; 79: 541–542.
10.
AlfonsiP., SesslerD.I., Du ManoirB.. The effects of meperidine and sufentanil on the shivering threshold in postoperative patients.Anesthesiology1998; 89: 43–48.
11.
JorisJ., BanacheM., BonnetF.. Clonidine and ketanserin are both effective treatment for post-anesthetic shivering.Anesthesiology1993; 79: 532–539.
12.
CheongK.F., LowT.C.Propofol and postanaesthetic shivering.Anaesthesia1995; 50: 550–552.
13.
HornE.P., StandlT., SesslerD.I.. Physostigmine prevents post-anesthetic shivering as does meperidine or clonidine.Anesthesiology1998; 88: 108–113.
14.
RosaG., PintoG., OrsiP.. Control of post anaesthetic shivering with nefopam hydrochloride in mildly hypothermic patients after neurosurgery.Acta Anaesthesiol Scand1995; 39: 90–95.
BurkeL.L., AisnerJ., FortnerC.L., WiernikP.H.Meperidine for the treatment of shaking chills and fever.Arch Intern Med1980; 140: 483–484.
17.
DewitteJ., DeloofT., De VeylederJ, HousmansP.R.Tramadol in the treatment of postanaesthesia shivering.Acta Anaes-thesiol Scand1997; 41: 506–510.
18.
PausawasdiS., JivarvilhamS., PhanarciiC.The use of tramadol hydrochloride in the treatment of shivering.J Med Assoc Thai1999; 73: 16–20.
19.
BruckK., HinckelP.Thermoafferent networks and their adaptive modifications. In: SchonbaumE., LomaxP., eds. Thermoregulation: Physiology and Biochemistry, New York, Pergamon Press, 1990; 129–152.
20.
WangJhi-Joung, HoShung-Tai, LeeShih-Chun. A comparison among nalbuphine, meperidine and placebo for treating postanesthetic shivering.Anesth Analg1999; 88: 686–689.
21.
ThomasH.Hassard.Understanding Biostatistics.Moshy Year Book, 1991, Toronto, 1991; 167–181.
