Effectiveness of meperidine versus tramadol on post spinal anesthesia shivering in elective cesarean section: A prospective observational cohort study

ABSTRACT Background: Post Spinal Anesthesia Shivering (PSAS) is common side effect during spinal anesthesia. Shivering could be treated with tramadol or meperidine. However, comparative effectiveness of the two drugs has not been assessed in our institution. Study objective: To evaluate effectiveness of meperidine versus tramadol on post spinal anesthesia shivering in mothers under go cesarean section. Methods: This prospective observational cohort study was conducted on74 ASA II and III obstetric mothers from December 20-March 20, 2017/18. Patients with PSAS received IV tramadol (0.5 mg/kg) or meperidine 0.5 mg/kg as independent decision of responsible anesthetist. Then they were followed for time of cessation of shivering, reoccurrence of shivering, hemodynamic changes, and occurrence of side effects such as sedation, nausea and vomiting. The collected data were entered Epi Info version 7.0 and exported to SPSS version 22. The mean difference of categorical data was analyzed with the Chi-Square test. Independent samples t-test or Mann-Whitney U test was used to evaluate numerical data -value less than 0.05 were considered statistical significance. Results: The mean time to ceased shivering was 4.45 ± 3.18 min and 3.08 ± 1.30 min in meperidine and tramadol groups, respectively (p = 0.021). The hemodynamic changes like mean arterial pressure (MAP), heart rate (HR), arterial saturation (SpO2) and body temperature changes were all comparable between the two groups. Recurrence of shivering after treatment was less in tramadol group 6 (16.2%) than meperidine group 9 (24.3%). Sedation, nausea and vomiting were reported as a side effect in both groups with no statistical significant (p > 0.05). Sedation was higher in Meperidine group 9 (24.3%) than tramadol group 3 (8.1%). Nausea and vomiting were found to be higher in tramadol group 9 (24.3%) than meperidine group 3 (8.1%). Conclusions: Both tramadol and meperidine effectively controlled shivering in clients during cesarean section under spinal anesthesia. Tramadol offered rapid onset, less recurrence and less sedation as a side effect when compared to meperidine. Highlights