Prevalance of Shivering Among Parturients Receiving Intrathecal Tramadol During Cesarean Section

Introduction: Spinal anesthesia is popular and preferred anesthesia of choice during cesarean section. Shivering is one of the inevitable complications of spinal anesthesia (which occurs due to heat loss and redistribution of body heat from core to periphery). T.he incidence of post-spinal shivering reported to be 40%-60%. Although shivering may have beneficial thermoregulatory effects, it places the body under increased physiological stress as it increases body oxygen demand by 3-4 folds, and increases metabolic rate, heart rate, blood pressure and even cause hypoxia, hypercapnia and lactic acidosis. Ideally, this should be prevented by pharmacological methods that are economically and practically feasible in all settings. Therefore, this study was conducted using tramadol 20 mg intrathecally along with bupivacaine prophylactically to prevent shivering after spinal anesthesia. Methods: This prospective observational study was carried out in 200 patients posted for emergency as well as routine cesarean delivery who received intrathecal Tramadol along with Bupivacaine at NMCTH. Shivering if present was noted and graded using a five-point intensity scale by Wrench et al. Result: Post-spinal shivering was observed in 36 (18%) patients. Among them, 22 (11%) patients had grade 1; 8 (4%) patients had grade 2; 6 (3%) patients had grade 3 shivering. None of the patients had grade 4 shivering. All patients had MOAA/S of 5, indicating that all the patients were fully awake and alert during the intraoperative period. Intraoperative nausea was seen in 26 (13%) patients while 14 (7%) patients had vomiting. None of the patients complaint of pruritus. Conclusion: The prevalence of post spinal shivering in patients who received intrathecal tramadol in our study was 18 %, which is lower as compared to studies conducted in parturient who did not receive intrathecal tramadol along with bupivacaine.