Volume 10 Issue 3 (May-June, 2024)

Original Articles

Comparative study of the effect of IV ketamine and IV tramadol for control of shivering in cases of caesarean section under spinal anaesthesia
Dr. Imran Ali Sofi, Dr. Abhishek Gupta, Dr. Pankaj Kaul

Background: This study was conducted to compare the effect of IV ketamine and IV tramadol for control of shivering in cases of caesarean section under spinal anaesthesia. Material and methods: This study comprised of 100 women aged 20-40 years with mean age of 30.5 years. The study omitted individuals with a history of opioid hypersensitivity, ketamine or bupivacaine sensitivity, cardiovascular disease, hypertension, psychosis, antepartum haemorrhage, cord prolapse, foetal distress, initial temperature >38°C or <36°C, history of alcohol or substance abuse, subjects who required blood transfusion during surgery or who received medications likely to alter thermoregulation, safe anaesthesia (SA) combined with intrathecal fentanyl, safe anaesthesia (SA) using propofol, pethidine, or ketamine, or patients who failed spinal conversion to general anaesthesia had not been included in the study.An 18-gauge IV cannula was placed and 10 mL/kg of normal saline was given prior to SA. For routine monitoring, an ECG, heart rate (HR), non-invasive blood pressure, and pulse oximetry were linked. Prior to SA, measurements were made of room temperature, tympanic temperature, and hemodynamic variables (blood pressure, heart rate, and oxygen saturation [SPO2]). Premedication was not given to the patients. The anaesthetist (who was blind to the study) used 22–25gauge Quincke spinal needles to initiate SA at either L3–L4 or L4–L5 while the patient was seated. 2.5 mL of 5% (12.5 mg) isobaric bupivacaine was injected. Statistical analysis was conducted using SPSS software. Results: In this study, out of 100 subjects, 50 (50%) belonged to Tramadol group and 50 (50%) belonged to Ketamine group.The mean arterial pressure in the tramadol group was 86 mm Hg and in ketamine group, it was 93 mm Hg. The pulse rate of subjects in tramadol group and ketamine group was 82 bpm and 90 bpm, respectively. The SPO2 of the subjects of tramadol group and ketamine group was 98% in both groups. The tympanic temperature in tramadol group and ketamine group was 37.2°C and 37.1°C, respectively. The 1-minute and 5-minute AGPAR scores in tramadol and ketamine group were 7 and 8, respectively. Time taken to extract teeth in subjects of tramadol group and ketamine group was 5 minutes and 6 minutes, respectively. Estimated blood loss in tramadol and ketamine group was 400 ml and 300 ml, respectively. In tramadol group, shivering was seen in 35 subjects and was absent in 15 subjects while in ketamine group, it was seen in 20 subjects and was absent in 30 subjects. 8 subjects of tramadol group and 7 subjects of ketamine group had grade 2 shivering and 7 subjects of tramadol group and 5 subjects of ketamine group showed grade 3 shivering while none of the subjects of both groups showed grade 4 shivering. Conclusion: IV tramadol or low-dose ketamine can be administered as a preventative measure to lessen the frequency and severity of shivering. For parturients undergoing spinal anaesthesia after a caesarean section, low-dose intravenous ketamine or tramadol prophylaxis is advised.

 
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