Raja Poovathai

Abstract

Background : Post anesthesia shivering is a common complication after spinal anesthesia. Intrathecal Magnesium sulphate (MgSO4) and tramadol are the most effective and safe adjuvants with minimal side effects. The aim of this study was to compare the effect of intrathecal tramadol versus intrathecal MgSO4 with bupivacaine for the prevention of post-spinal anesthesia shivering. Materials and Methods: In this prospective randomized, double-blinded controlled study, 105 patients scheduled for infraumbilical surgeries were randomly allocated into three groups. Group C(35) received 3.0ml of hyperbaric bupivacaine 0.5% (15mg)+0.5ml of normal saline, Group T (35) received 3.0ml of hyperbaric bupivacaine 0.5% (15mg)+25mg of tramadol in 0.5ml saline, and Group M (35) received 3.0ml of hyperbaric bupivacaine 0.5% (15mg)+100mg of magnesium sulphate in 0.5ml saline. The primary outcomes were to find the incidence and intensity of shivering. The secondary outcome was to find out the incidence of complications. Results : All the 3 groups were comparable with respect to demographic characteristics. Shivering was observed in 68.6% of the patients in Group C, 48.6% patients in Group T and 40% patients in Group M. The incidence of shivering were statistically significant between Groups C and T (P= 0.003) and Groups C and M (P=0.001) but not between Groups T and M (P=0.480). The incidence of complications such as hypotension, bradycardia, nausea, vomiting,itching and respiratory depression were not statistically significant in between the groups. Conclusion: This study concluded that both intrathecal MgSO4 100mg and tramadol 25mg with hyperbaric bupivacaine reduces the incidence and intensity of shivering compared to control group after spinal anesthesia.   Keywords: Tramadol, Magnesium sulphate, Shivering, Spinal anesthesia, Intrathecal

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Abstract

Background: Surgeries involving infraumblical regions are commonly done under spinal anaesthesia. No single adjuvant to bupivacaine found to prolong the duration of analgesia and to reduce its limitations. Objectives: To compare the block characteristics of intrathecal administration of dexmedetomidine and magnesium sulfate as an adjuvant with bupivacaine in infraumblical surgeries. Materials and Methods: This is a prospective randomized double-blinded study. Around 90 American Society of Anaesthesiologist physical status I and II patients, scheduled for infraumblical surgeries were enrolled in this study. Patients were randomly assigned into Group B (bupivacaine), Group D (bupivacaine plus dexmedetomidine) and Group M (bupivacaine plus magnesium sulfate). In the operating theatre, baseline values were recorded. Onset and duration of sensory and motor block, time of rescue analgesia were noted. Results: The onset of sensory block was rapid in Group D (2.63 ± 0.66 min) and slow in Group M (6.35 ± 0.87 min) when compared to Group B (2.93 ± 0.785 min) with a statistically significant difference. Motor duration (min) was prolonged in Group D (423.00 ± 12.360) and early in the Group M (165 ± 31.55) when compared to Group B (219.23 ± 14.875). Conclusion: For the surgery, which requires prompt onset and long duration of analgesia,dexmedetomidine can be used as an adjuvant. However, surgical procedures that permit delayed onset block and shorter duration of analgesia,magnesium sulfate can be preferred. Keywords: Dexmedetomidine, Bupivacaine and magnesium sulfate.

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