Comparing the Effects of Low Dose of Ketamine, Tramadol, and Ondansetron in Prevention of Post Spinal Anesthesia Shivering in Cesarean Section

Comparison of the effects of norepinephrine and phenylephrine on shivering and hypothermia in patients undergoing caesarean section under spinal anaesthesia at a tertiary hospital in China：a randomised, double-blind, controlled trial protocol

INTRODUCTION

Peripheral vasodilation causes a redistribution of body temperature from the core to the periphery, resulting in shivering and hypothermia. These are normal pathological and physiological processes during spinal anaesthesia. Two drugs, norepinephrine and phenylephrine, have peripheral vasoconstrictive effects. It is unclear the effects of norepinephrine and phenylephrine on shivering and hypothermia in patients undergoing caesarean section under spinal anaesthesia.

METHODS ANALYSIS

240 eligible parturients will be recruited for this randomised, double-blind, controlled trial and randomly assigned to either the norepinephrine or phenylephrine groups. The primary outcome will be the incidence of shivering while secondary outcomes will include the severity of shivering, rectal temperature, incidence of hypothermia and umbilical artery blood pH value.

ETHICS AND DISSEMINATION

The Institutional Ethics Committee of The Second People's Hospital of Hefei approved the trial protocol (ID: 2023-093). The results will be published in a compliant journal. The original data will be released in December 2029 on the ResMan original data-sharing platform of the China Clinical Trial Registry (http://www.medresman.org.cn).

TRIAL REGISTRATION NUMBER

ChiCTR2300077164.

Comparative Efficacy of Intravenous Ketamine and Tramadol in Reducing Postspinal Anesthesia Shivering in Urological Surgeries: A Triple-blind Randomized Clinical Trial

Objective

Shivering is one of the most common complications due to disturbances in the thermoregulatory system after regional anesthesia, leading to adverse outcomes and decreased patient satisfaction. Ketamine and tramadol are considered mild analgesics that affect the thermoregulatory center. This triple-blind, randomized clinical trial aims to explore the comparative efficacy of intravenous ketamine and tramadol in reducing postspinal anesthesia shivering in high-risk urological surgeries.

Methods

A total of 90 patients undergoing urological surgeries under spinal anesthesia at Shahid Hasheminejad Hospital in Tehran in 2024 were randomized into three groups: ketamine (0.5 mg/kg), tramadol (0.5 mg/kg), and placebo (normal saline). Variables, including ambient temperature, patient demographics, surgery duration, and anesthetic techniques, were meticulously controlled. The primary outcome was the incidence of shivering, measured using the Crossley and Mahajan scale. Data were analyzed using the SPSS software Version 19, employing Chi-square tests, analysis of variance, and logistic regression.

Findings

The patients were homogeneous regarding demographic and surgical variables. No significant difference was found in patients' body temperature upon admission. The incidence of shivering was significantly lower in the tramadol group (23.3%) compared to the ketamine group (36.7%) and placebo group (60%) (P = 0.013). Tramadol demonstrated superior efficacy with minimal side effects. Logistic regression analysis confirmed that patients in the tramadol group were significantly less likely to experience shivering (odds ratio = 0.286; 95% confidence interval: 0.098-0.834, P = 0.022). Ketamine, while effective, had a higher incidence of hemodynamic fluctuations and psychotropic effects.

Conclusion

The incidence of shivering was significantly lower in the tramadol group compared to the ketamine and placebo groups. Tramadol demonstrated superior efficacy with minimal side effects. While effective, ketamine had a higher incidence of hemodynamic fluctuations and psychotropic effects.

The effects of intravenous tramadol vs. intravenous ketamine in the prevention of shivering during spinal anesthesia: A meta-analysis of randomized controlled trials

Background

Shivering is a common complication after subarachnoid administration of local anesthetics. Intravenous ketamine and tramadol are widely available anti-shivering drugs, especially in developing settings. This meta-analysis aimed to compare the effects of intravenous ketamine vs. tramadol for post-spinal anesthesia shivering.

Materials and methods

PubMed/MEDLINE, Web of Science, Cochrane Library, Embase, and Google Scholar databases were used to search for relevant articles for this study. Mean difference (MD) with 95% confidence interval (CI) was used to analyze continuous outcomes, and risk ratio (RR) with 95% CI to analyze categorical results. The heterogeneity of the included studies was assessed using the I2 test. We utilized Review Manager 5.4.1 to perform statistical analysis.

Results

Thirteen studies involving 1,532 patients were included in this meta-analysis. Ketamine had comparable effects in preventing post-spinal anesthetics shivering [RR = 1.06; 95% CI (0.94, 1.20), P = 0.33, I ² = 77], and onset of shivering [MD = -0.10; 95%CI (- 2.68, 2.48), P = 0.94, I ² = 0%], lower incidences of nausea and vomiting [RR = 0.51; 95%CI (0.26, 0.99), P = 0.05, I ² = 67%], and lower incidences of bradycardia [RR = 0.16; 95%CI (0.05, 0.47), P = 0.001, I ² = 33%], higher incidence of hallucinations [RR = 12; 95%CI (1.58, 91.40), P = 0.02, I ² = 0%], and comparable effects regarding the incidences of hypotension [RR = 0.60; 95%CI (0.30, 1.21), P = 0.15, I ² = 54%] as compared to tramadol.

Conclusions

Intravenous ketamine and tramadol are comparable in the prevention of post-spinal anesthetic shivering. Ketamine had a better outcome with less occurrences of nausea, vomiting, and bradycardia. However, ketamine was associated with higher incidences of hallucinations than tramadol.

Effects of Ketamine and Lidocaine Infusion on Acute Pain after Elective Open Abdominal Surgery, a Randomized, Double-Blinded Study

Background: Most patients suffer from moderate to severe pain after elective laparotomy. They often require opioids to alleviate their pain. Opiates invariably induce certain side effects and, occasionally, dependence. Intraoperative infusion of lidocaine and low-dose ketamine reduces postoperative pain and analgesic requirements. This study aims to evaluate the effects of simultaneous infusion of lidocaine and ketamine during open abdominal surgery on the postoperative pain severity and analgesic consumption. Methods: In this randomized, double-blinded, single-center study that was performed in Iran, 80 patients scheduled for elective open abdominal surgery under general anesthesia were enrolled in two LK and P groups. Group LK (n=40) received lidocaine-ketamine infusion, and group P (n=40) received placebo (normal saline). Both infusions were started thirty minutes after initiation of surgery and were terminated once the surgery was completed. For postoperative pain management, patient-controlled analgesia (PCA), including fentanyl and paracetamol, was administered for both groups. All patients were evaluated for pain visual analogue scale (VAS) and total adjunctive analgesic (diclofenac suppository) consumption within the first 24 hours after the surgery. The data were analyzed using SPSS. P values <0.05 were considered significant. Results: Intraoperative infusion of Lidocaine and Ketamine resulted in desirable postoperative pain control. Patients of LK group demonstrated a significant reduction in the pain score at 1, 6, 12, 18, and 24 hours after termination of surgery (p<0.001). It also resulted in a decreased requirement for postoperative analgesics, as cumulative analgesic consumption was decreased meaningfully in the patients of LK group (p<0.001). Conclusion: Intravenous infusion of lidocaine and ketamine during elective open abdominal surgery reduces pain intensity and analgesic requirements in the first 24 hours postoperatively, without major additional side effects.