Tramadol For Control Research Articles

A PROSPECTIVE RANDOMIZED STUDY OF COMPARISON OF PROPHYLACTIC KETAMINE, CLONIDINE AND TRAMODOL FOR THE CONTROL OF SHIVERING UNDER NEURAXIALANAESTHESIA

Background: Thermoregulatory system coordinates defenses against environmental temperature to maintain internal core temperature within a narrow range, thus optimizing normal body function and homeostasis in humans. Anaesthetic induced thermoregulatory impairment and hence hypothermia in cold environments. Shivering is an important complication of hypothermia. Shivering is an involuntary, oscillatory muscular activity that augments metabolic heat production upto 600% above basal level to increase temperature. It is associated with substantial adrenergic activation, discomfort and can double or even triple oxygen consumption and carbon dioxide production. Potent anti-shivering properties have been attributed to numerous drugs including biogenic monoamines, cholinomimetics, cations, endogenous peptides and possibly N-methyl-D- aspartate (NMDA) receptor antagonists like ketamine, tramadol and clonidine. Aim: To evaluate the effectiveness of prophylactic use of intravenous ketamine, clonidine and tramadol in control of shivering and to note any side-effects of the drugs used. Methods: A total number of 120 ASA I and 2 patients of either sex belonging to age group 18-60 years posted for Lower Abdomen and Lower Limb surgeries under subarachnoid block were divided into four groups of 30 each. Group P (control group): Patients received 10mL of normal saline IV as placebo. Group K: Patients received Inj. Ketamine 0.5mg/kg BW IV diluted to 10ml in Normal Saline. Group C: Patients received Inj. Clonidine 75mcg IV diluted to 10ml in Normal Saline. Group T: patients received Inj. Tramadol 0.5mg/kg BW IV diluted to 10ml in normal saline. Results: We conclude that giving Ketamine 0.5mg/kg,Clonidine 75mcg or tramadol 0.5mg/kg i.v. prophylactically just before subarachnoid block significantly decreased the incidence of shivering without causing any major side effects. Conclusion: Ketamine, Tramadol or Clonidine decrease shivering during spinal anesthesia.

Comparative study of ketamine, clonidine and tramadol for control of shivering under neuroaxial anaesthesia

Comparative study of ketamine, clonidine and tramadol for control of shivering under neuroaxial anaesthesia

Comparison of the effectiveness of oral morphine versus oral tramadol on early pain control in opioid-naive patients with moderate cancer pain.

11581 Background: Adequate pain control, an essential part of cancer care remains a challenge in resource limited countries like Nepal. Early use of morphine for Moderate Cancer Pain (MCP) and not sequential World Health Organization (WHO) analgesic ladder seems reasonable in the setting of limited access to health care. The purpose of this study was to compare efficacy of oral Morphine (MOR) with oral Tramadol (TRM) in control of pain as well as physical wellbeing in patients (pts) with MCP using Edmonton Symptom Assessment Scale (ESAS). Methods: An IRB approved randomized phase II trial was performed in opioid-naive pts with MCP as defined by pain score in Numerical rating score (NRS)of 4-6.Patients were randomized to receive MOR syrup 5 mg 4 hourly or TRM 50 mg four times a day. Titration of dose was done in both groups for 3 days as per standard recommendation for MOR or till maximum recommended daily dose for TRM. MOR was changed to prolonged release form at Day 4.The primary endpoint was number of early responders, defined as pts with at least 20% reduction in pain intensity on NRS on Day 3. Secondary outcome was number of patients with highly meaningful pain reduction, defined as decrease in pain intensity on NRS by ≥ 5 and improvement in physical well-being with ESAS at Day 7. Results: 68 pts consented and were randomized, 34 in each arm. The primary endpoint occurred in 94.1% pts in MOR and 55.9% in TRM (p <0.001). Number of patients with highly meaningful pain reduction was significantly higher in MOR than in TRM (76.5% vs. 32.35%; p<0.001). Improvement in general physical wellbeing as assessed by ESAS was better in morphine group. No difference in adverse effects was noted between the treatment arms. Conclusions: In this study Morphine was superior to Tramadol in the control of pain with statistically significant difference in the primary and secondary endpoints. So, early use of morphine skipping the WHO sequential analgesic ladder for moderate cancer pain seems a higher value option in resource scarce country with limited access to healthcare.

Comparative Study of Intravenous Butorphanol and Intravenous Tramadol for Control of Intra-operative Shivering Under Spinal Anesthesia

Comparative Study of Intravenous Butorphanol and Intravenous Tramadol for Control of Intra-operative Shivering Under Spinal Anesthesia

A Comparative Evaluation of Dexmedetomidine and Tramadol for Control of Post-spinal Anesthesia Shivering

A Comparative Evaluation of Dexmedetomidine and Tramadol for Control of Post-spinal Anesthesia Shivering

Comparison of Pethidine and Tramadol for Control of Shivering in Patients undergoing Elective Surgery under Spinal Anesthesia

Introduction: Shivering is a common problem faced by an anesthesiologist during intraoperative as well as in postoperative period, specially after sub-arachnoid block (SAB). It is unpleasant and undesirable and is secondary to vasodilation following sympathetic blockade. The present study was designed to evaluate the efficacy of pethidine on postoperative shivering following SAB and to compare its effects with those of tramadol.
 
 Methods: This randomized, prospective study was conducted in American society of anesthesiologists (ASA) grade I and II patients undergoing surgery under SAB, to compare the efficacy of tramadol and pethidine for control of shivering. Patients received tramadol or pethidine in a dose of 0.5mg/kg intra-venously after the appearance of shivering. Disappearance of shivering, side-effects as well as hemodynamics were observed at scheduled intervals.
 
 Results: There were a total of 79 patients randomized into two groups. There were 44 patients receiving pethidine (Group P) and the rest 35 receiving tramadol (Group T). Shivering score was significantly lower in Group P at 10, 15, 20, and 30 minutes compared to that in Group T. Sedation score was higher in pethidine group. Adverse effects in terms of nausea and vomiting was significantly higher in Group T.
 
 Conclusion: Pethidine provide better anti-shivering effect then tramadol with less side effects (nausea and vomiting) but more sedation.

A Prospective, Randomized, Double blinded, Comparative Study of Clonidine and Tramadol for Control of Shivering under Spinal Anesthesia

Corresponding Author Dr Sowmya M Jois No 335, I Floor, 10th main Srinivasnagar, Bangalore, Karnataka, India Email: drsowmyasharma@gmail.com ABSTRACT BACKGROUND: Shivering is a common complication of spinal anesthesia. We compared the efficacy of intravenous clonidine and tramadol for the treatment of shivering under spinal anesthesia. MATERIALS AND METHODS: In this prospective, randomised, double blinded, comparative study, 80 patients coming for lower abdominal and lower limb surgeries under spinal anesthesia were included. Patients were grouped into group C and group T who received clonidine 0.5mcg/kg and tramadol 0.5mg/kg respectively after the onset of shivering. Time of onset of shivering, cessation of shivering after administration of drug, vital signs and side effects were noted. RESULTS: Time of cessation of shivering was shorter in group C compared to group T (2.51±0.66minutes and mean time taken by Tramadol to control shivering was 4.82±0.90 min). Group C had more incidence of decrease in heart rate and blood pressure and higher sedation scores. Group T had higher incidence of nausea and vomiting. CONCLUSION: Our study concludes that both study drugs Clonidine and Tramadol are effective in controlling shivering under spinal anesthesia but clonidine took shorter time to achieve cessation of shivering compared to tramadol. There is a significant improvement in SPO2 values following control of shivering. Clonidine causes decrease in heart rate and systolic blood pressure. The occurrence of bradycardia, hypotension, dry mouth, sedation is higher in clonidine group. The occurrence of nausea and vomiting are higher in Tramadol group compared to clonidine group. Clonidine is safer and effective alternative to Tramadol in controlling shivering in patients receiving spinal anesthesia for surgery. KEYWORDS-spinal, shivering, anesthesia, clonidine, tramadol

Efficacy of intravenous tramadol in the control of shivering following spinal anaesthesia for caesarean section.

The aim of this study was to evaluate the efficacy of intravenous tramadol in control of shivering in obstetric patients under spinal anaesthesia and to determine the minimal dose of tramadol that is effective. This was a prospective, randomised, double-blind, cross-sectional study of 144 pregnant women at term who had an indication for caesarean section. The patients were randomly allocated into three groups at the occurrence of shivering. Group T0.5 received 0.5 mg/kg of tramadol (n = 47), Group T0.25 received 0.25 mg/kg tramadol (n = 47) and Group TNS received 0.05 ml/kg of normal saline (n = 46). Statistical analysis was performed using Statistical Package for Social Sciences version 17. There were no significant differences between the groups with regard to age, weight and duration of surgery. There was a statistically significant difference in the time of cessation of shivering after the treatment for various groups (P = 0.000). A total of 80.1% responded to the treatment in Group T0.5, while for Group T0.25 and TNS, a total of 44.7% and 4.3%, respectively, responded. There were statistically significant differences in the recurrence rates of shivering among the groups (P = 0.000). Tramadol is effective in control of shivering during spinal anaesthesia in obstetric patients. Tramadol 0.5 mg/kg controlled shivering better than 0.25 mg/kg. Therefore, 0.5 mg/kg of tramadol can be used to manage shivering following caesarean section under spinal anaesthesia.

Comparison of clonidine and tramadol for the control of shivering under spinal anaesthesia

Objectives- This study aimed to evaluate the relative efficacy of intravenously administered clonidine and tramadol for control of intraoperative shivering following spinal anaesthesia. Materials and Methods- A prospective, randomized, clinical controlled study was conducted on 60 ASA grade-I &II patients of either sex, aged 18-40 years, scheduled for elective lower abdominal and lower limb surgeries, under spinal anaesthesia. Patients who developed post spinal intraoperative shivering of grades 3 or 4, lasting for minimum period of 2minutes were included in the study, and randomly allocated to one of the two groups, group C (n=30), received Inj. clonidine 50g i.v., and group T (n=30), received Inj. tramadol 50mg i.v. when shivering was observed. Time taken for control of shivering, response rate, recurrence rate, and side effects were observed. Results- The response rate was significantly higher in tramadol group than clonidine group at 1min, 2mins, 3mins and 5mins intervals and comparable in both groups at 15 mins. The average time taken for disappearance of shivering was higher in clonidine group i.e. 5.76 0.88mins as against 3.16 0.84mins in tramadol group (P=0.038). Patients with incomplete response and recurrence were more in clonidine group. Side effects like hypotension, bradycardia, sedation and dry mouth were observed in clonidine group patients, and nausea and vomiting in tramadol group, but were controllable. Conclusion-Tramadol is better as compared to clonidine for control of intraoperative shivering under spinal anaesthesia due to rapid onset, higher response rate, lesser recurrence, lesser sedation and lesser hemodynamic alterations.

Decision to control tramadol results from learning how it is used or abused

Decision to control tramadol results from learning how it is used or abused

Randomized double-blind comparison of prophylactic ketamine, clonidine and tramadol for the control of shivering under neuraxial anaesthesia

Background:Shivering is a common problem during neuraxial anaesthesia. Neuraxial anaesthesia impairs thermoregulatory control and up to a 56.7% incidence of shivering has been reported.Aim:To evaluate the effectiveness of prophylactic use of intravenous ketamine, clonidine and tramadol in control of shivering and to note any side-effects of the drugs used.Setting and Design:Randomised double-blind study.Methods:This study was conducted in 200 ASA grade I and II patients. Neuraxial block was performed with 2.8 mL (14 mg) of 0.5% bupivacaine heavy in all patients. The patients were randomly allocated into four groups of 50 each to receive saline as placebo (group P), ketamine 0.5 mg/kg (group K), Clonidine 75 mcg (group C) and Tramadol 0.5 mg/kg (group T). Temperature and hemodynamic parameters were recorded at every 5-min interval. Shivering was graded from 0 to 4 grades and, if grade 3 shivering occurred, the study drug was considered as ineffective and intravenous pethidine 25 mg was given as rescue drug.Statistical Analysis:Data among groups was compared using one-way ANOVA. The incidence of shivering and side-effects were compared using the chi-square test.Results:The incidence of grade 3 shivering showed a statistically significant difference (P=0.001) in group P (27/50) as compared with the other groups (group K=5/50, group C=2/50, group T=4/50). No drug showed any statistically significant advantage over the other. No major hemodynamic changes were seen with prophylactic use of test drugs; however, sedation score was significantly higher in group K (P<0.05) as compared with the other groups.Conclusion:The prophylactic use of ketamine, clonidine and tramadol were effective in preventing shivering during neuraxial anaesthesia without causing any major untoward side-effects.

Control of shivering with clonidine, butorphanol, and tramadol under spinal anesthesia: a comparative study

IntroductionThe present study was designed to evaluate the efficacy of clonidine, butorphanol, and tramadol in control of shivering under spinal anesthesia, and to compare their side effects.MethodsThis randomized, prospective study was conducted in 90 patients who developed shivering under spinal anesthesia during various abdominal or orthopedic surgery procedures. On shivering, patients were randomly allocated to receive an intravenous, 1 mL bolus dose of 50 mg tramadol, or 1 mg butorphanol, or 150 μg clonidine, in a double blinded manner. Control of shivering, time taken for cessation, recurrence, hemodynamic changes, axillary temperatures, and side effects were noted and compared for all 3 groups. Collected data were analyzed using appropriate statistical tests.ResultsButorphanol and tramadol were more effective than clonidine in suppressing shivering. Butorphanol, tramadol, and clonidine completely controlled rigors in 83%, 73%, and 53% of cases, respectively, and incompletely suppressed rigors in 16%, 26%, and 46% of cases, respectively. Time taken to terminate rigors was significantly higher for clonidine (3.3 ± 0.9 minutes) than for butorphanol and tramadol (2.1 ± 1.0 minutes and 1.8 ± 0.5 minutes; P < 0.001).ConclusionButorphanol had an edge over tramadol in controlling shivering with lower chances of recurrence, though both were superior to clonidine for this purpose with an early onset of action. We conclude that both these opioids control rigors better than α-2 agonists.