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Incidence of shivering and analgesic quality and complications after cesarean section under spinal anesthesia with or withoutintrathecalsufentanil and tramadol
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| Author:
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ELHAM SAFFARIEH, BABAK HOSSEINZADEH ZOROUFCHI , ATOUSA NAJMALDIN, SETARE NASSIRI
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| Abstract:
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Introduction: Postoperative shivering and pain are common complications following both general anesthesia and
spinal anesthesia. Different ways have been used to prevent and treat this condition, such as warming the operating
room and the patient, prescribing hot liquids, as well as wet and hot gases. In addition, there are several
therapeutic agents that include pethidine, clonidine, ketanserin, anticholinergics, opioid agonists, dexamethasone,
and finally tramadol. The search for appropriate drug combinations and anesthetic methods seems to be necessary,
and the addition of some supplements to topical anesthetics increases the duration of analgesia and reduces
postoperative complications such as shivering. The aim of this study was to evaluate the effect of tramadol and
sufentanil on prevention of shivering following cesarean section under spinal anesthesia.
Materials and Methods: This study was a double blind randomized clinical trial, 135 pregnant women(ASA class
I & II) who were candidates for cesarean section were selected and divided into three groups (each group consists
of 45 patient). All patients underwent spinal anesthesia, control group spinal anesthesia received bupivacaine and1
cc distilled water, the first intervention group received bupivacaine + 10 mg tramadol, the second intervention
group received 5 µg (1 ml) of sufentanil + bupivacaine. Patients were evaluated for hemodynamic symptoms (heart
rate, systolic and diastolic blood pressure), incidence and severity of shivering intensity and nausea and vomiting.
Data were analyzed using Chi-square test and independent t-test.
Results: The results showed that 30 patients (66.6%) from sufentanil group and 18 patients (40%) from tramadol
group and 32 patients (71.1%) from control group was shivered. Twelve patient(26.6%) in control group and
4patients(8.8%) in sufentanil group had severe and relatively severe shivering, In the tramadol group there was no
case of severe and relatively severe shivering. The incidence and severity of shivering in the three groups were
significantly different (P <0.001). The incidence of nausea, shivering and analgesia were significantly different
between the three groups. The incidence of vomiting, hypotension, tachycardia, VAS, and neonatal Apgar score
were not significantly different in the three groups.
Conclusion: The results of this study show that tramadol is an effective drug in preventing shivering and
increasing the duration of analgesia following cesarean section. The results of tramadol supplementation are better
for increasing the period of analgesia and decreasing the complications, and are preferable to sufentanil and can be
used as a supplement in spinal anesthesia to reduce the complications and increase the period of analgesia.
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| Keyword:
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Cesarean section, Tramadol, Sufentanil, Spinal anesthesia, Postoperative shivering.
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