Effectiveness of preoperative oral tramadol in preventing perioperative shivering in geriatric patients for transurethral resection of prostate surgery under spinal anesthesia.
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Date
2019-06
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Addis Ababa University
Abstract
Background: Spinal anesthesia is widely used as a safe anesthesia technique for both elective
and emergency surgeries. Shivering is a frequent complication, distressing for the patients
undergoing surgery under both regional and general anesthesia. Regional anesthesia has been
known to be associated with greater heat loss than general anesthesia. Post anesthetic shivering
may cause discomfort to patients, and aggravate wound pain by stretching incisions and increase
intracranial and intraocular pressure. Shivering increase tissue oxygen demand by as much as
500% and accompanied by increase in minute ventilation and cardiac output to maintain aerobic
metabolism. Elderly patients are especially at risk of hypothermia under anesthesia, as low core
temperatures may not initiate autonomic protective response.
Objective: To assess the effectiveness of oral tramadol in preventing perioperative shivering in
patients undergoing TURP surgery at Hawassa university comprehensive specialized hospital
from February to May 2019 GC.
Method: A prospective cohort study design was employed. Sample size was calculated by using
double proportion formula with equal sample size where n1=sample for oral tramadol group,
n2=sample for control group and the final Sample size became n1= n2=30
A systemic random sampling technique was used to select study participants. Data was collected
by using structured questionnaire. Based on normality assumption, analysis was done by
independent sample t test, χ2 ,Mann–Whitney U-test and Kaplan meier as appropriate. P value
<0.05 was considered as statistically significant.
Result: The incidence of shivering was significantly less in patients who received preoperative
oral tramadol group than those of control group. (13.3% vs. 80%, p<0.001).Grades of shivering
were also significantly different with only grades 1-3 in oral tramadol compared to 2-4 grades
of shivering revealed in those who didn’t took it with p=0.006. Patients who didn’t took oral
tramadol experience shivering in the first 20 minutes after spinal anesthesia performed when
compared to tramadol groups with log rank test -p=0.015 .
Conclusion and Recommendation: our study demonstrate that taking 50 mg oral tramadol
before two hours of the operation time was effective to decrease the incidence, severity and delay
the onset of shivering which occur after spinal anesthesia for geriatric patients who undergo
transurethral resection of prostate surgery. Based on this we recommend that oral tramadol is one
of widely available drug in our country. So ordering it as perioperative shivering prophylaxis is a
good option to improve the clinical quality of our patient management.
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Keywords
Oral tramadol, perioperative shivering, geriatrics