Pre-induction low dose pethidine does not decrease incidence of postoperative shivering in laparoscopic gynecological surgeries

Comparison of adjuvant therapy with midazolam, paracetamol, tramadol, or magnesium sulfate during intravenous regional anesthesia with ropivacaine: A randomized clinical trial

Background

Intravenous (IV) regional anesthesia is an easy, safe, reliable, and efficient option for inducing anesthesia during surgeries but with tourniquet-related pain. This study aimed to evaluate midazolam, paracetamol, tramadol, and magnesium sulfate administration as adjuvants with ropivacaine on pain relief and hemodynamic changes in IV regional anesthesia.

Methods

A randomized, double-blind, placebo-controlled trial was conducted in subjects undergoing forearm surgery with IV regional anesthesia. The block randomization method was used to assign eligible participants to each of five study groups. Hemodynamic parameters were assessed before applying the tourniquet, at prespecified time points (5, 10, 15, and 20 min), then and every subsequent 10 min until surgery completion. A Visual Analog Scale was used to assess pain severity at baseline followed by every 15 min until completion of the surgery, and after tourniquet deflation every 30 min to 2 h, and at 6, 12, and 24 h postoperative. Data were analyzed using Chi-square and analysis of variance with repeated data testing.

Results

The shortest onset and the longest duration of sensory block were observed in the tramadol group and the shortest onset of motor block in the midazolam group (P < 0.001). Pain score was estimated to be significantly lower in the tramadol group at the time of tourniquet application and release, and 15 min to 12 h after tourniquet release (P < 0.05). In addition, the lowest dose of pethidine consumption was observed in the tramadol group (P < 0.001).

Conclusion

Tramadol appeared to be able to effectively relieve pain, shorten the onset of sensory block, prolong the duration of sensory block, and achieve the lowest consumption of pethidine.

Association Between Bispectral Index (BIS) Value and Postoperative Shivering in Patients Undergoing Orthopedic Surgery

BACKGROUND:

Postoperative shivering is one of the most common adverse effects after general anaesthesia.

AIM:

This study aimed to evaluate the association between the Bispectral index (BIS) monitoring value and postoperative shivering in patients undergoing orthopaedic surgery.

MATERIAL AND METHODS:

This cross-sectional study was conducted in Shahid Beheshti Hospital in Sabzevar city, from August 2017 to September 2018. Patients who underwent orthopaedic surgery, using general anaesthesia, were enrolled. Recording of the depth of anaesthesia using BIS monitoring was started exactly 5 minutes after intubating the patient and continued until the discharge from post-anesthesia care unit (PACU). The incidence of postoperative shivering was evaluated using a scale proposed by Crossley and Mahajan.

RESULTS:

A total number of 80 patients were evaluated. 32.5% of patients experience postoperative shivering grade 2, with mean BIS score 41.85. The univariate and multivariate linear regression analysis indicated a statistically significant relationship between shivering score and patients’ heart rate, blood pressure, BIS score, temperature, age, height, gender and blood cell distribution width (RDW) (p < 0.05).

CONCLUSION:

The results of this study indicate a significant positive association between BIS value and postoperative shivering in patients undergoing orthopaedic surgery, so that, patients with higher BIS score experienced significantly more postoperative shivering. It seems that BIS-guided anaesthesia can reduce the risk and incidence of postoperative shivering in patients undergoing orthopaedic surgery.

Comparative efficacy of intravenous dexmedetomidine, clonidine, and tramadol in postanesthesia shivering

Background and Aims:

Postanesthesia shivering continues to be a major challenge in the perioperative care. We compared the efficacy of tramadol, clonidine, and dexmedetomidine in preventing postoperative shivering and its potential adverse effects in patients undergoing laparoscopic cholecystectomy under general anesthesia.

Material and Methods:

One hundred and twenty American Society of Anesthesiologists I and II patients scheduled for elective laparoscopic cholecystectomy under general anesthesia were divided into four equal groups. Group 1 received clonidine 2 μg/kg, Group 2 received tramadol 1 mg/kg, Group 3 received dexmedetomidine 1 mcg/kg all intravenous diluted in NS to 5 ml, and Group 4 received NS intravenous 5 ml. Parameters analysed included postoperative blood pressure (BP), pulse rate, respiratory rate (RR), arterial saturation, and tympanic membrane temperature. Patients were observed for shivering episodes, sedation, pain, respiratory depression, nausea, and vomiting. Analysis of variance, Tukey's post-hoc comparison, Chi-square test and Bonferroni post-hoc comparison test were performed using SPSS (Statistical analysis by Statistical Package of Social Sciences of Microsoft Windows) Statistics (version 16.0).

Results:

The incidence of shivering was 10, 3.3, 13.3 and 40% in Groups 1, 2, 3, and 4 respectively. Patients who were given tramadol had significantly less shivering than patients in clonidine and dexmedetomidine groups (P < 0.01).

Conclusion:

All the three drugs were effective in preventing postoperative shivering. However, tramadol has been found to be more efficacious in preventing postoperative shivering.

Prophylactic Effects of Doxapram, Ketamine and Meperidine in Postoperative Shivering

Background:

Postanaesthetic shivering is one of the most common unpleasant complications in patients.

Objectives:

The aim of this study was to compare the efficacy of doxapram, ketamine and meperidine in prevention of shivering after anaesthesia.

Patients and Methods:

In this randomized, double-blind clinical trial, 120 patients aged between 20 - 45 years old under general anaesthesia were enrolled. The patients were randomly allocated into one of three groups: group M received 20 mg meperidine (n = 40), group K received 0.25 mg/kg ketamine (n = 40) and group D received 0.25 mg/kg doxapram (n = 40). All of the drugs were administered intravenously. The core temperature, shivering, time of the first postoperative analgesic requirement, and some of the other side effects were recorded. Obtained data from the three groups were compared using one-way ANOVA and chi-square test.

Results:

Three patients (7.5%) of group K, four patients (10%) of group D and one patient (2.5%) of group M experienced shivering (P = 0.39). The interval to the first analgesic requirement significantly prolonged in the groups K and M compared to the group D (P < 0.001). No significant differences were identified in nausea and vomiting among the groups. No significant pharmaceutical adverse effects were observed in our study.

Conclusions:

The results of this study showed that ketamine, doxapram and meperidine are equally effective in the prevention of postoperative shivering.