COMPARISON OF NALBUPHINE HYDROCHLORIDE AND TRAMADOL HYDROCHLORIDE FOR CONTROLLING POST-SPINAL ANESTHESIA SHIVERING

Authors

  • Gul Rukh Khyber Teaching Hospital, Peshawar, Pakistan. Author
  • Umbrin Naz Khyber Teaching Hospital, Peshawar, Pakistan. Author
  • Romaila Mumtaz Khyber Teaching Hospital, Peshawar, Pakistan Author
  • Parhaizgar Khan Khyber Teaching Hospital, Peshawar, Pakistan. Author

DOI:

https://doi.org/10.71000/80wh9r05

Keywords:

Anesthesia, Hypothermia, Intravenous Injections, Nalbuphine, Postoperative Complications, Spinal Anesthesia, Tramadol

Abstract

Background: Shivering following spinal anaesthesia is a common postoperative complication that can lead to patient discomfort, increased metabolic demand, and delayed recovery. Effective management of post-spinal shivering is essential for optimizing patient outcomes and enhancing perioperative care. Among pharmacologic agents used to control shivering, tramadol and nalbuphine are widely employed due to their central mechanisms of action. However, limited data exists comparing their efficacy, particularly within the local clinical setting.

Objective: To compare the efficacy of intravenous nalbuphine and tramadol in controlling shivering following spinal anaesthesia.

Methods: This randomized controlled trial was conducted in the Anesthesiology Department of Khyber Teaching Hospital, Peshawar, from 05-February to 05-August 2024. A total of 74 patients aged 18–75 years who developed shivering after spinal anaesthesia were enrolled and randomized into two equal groups. Group A (n = 37) received intravenous nalbuphine hydrochloride (0.06 mg/kg) and Group B (n = 37) received intravenous tramadol hydrochloride (1 mg/kg), both diluted in normal saline and administered over five minutes. The primary outcome was the time to control shivering, assessed by an experienced anesthesiologist. Data were analyzed using SPSS version 23, with a p-value ≤ 0.05 considered statistically significant.

Results: The mean age was 53.30 ± 14.55 years in Group A and 51.65 ± 14.70 years in Group B. Mean time to control shivering was 4.92 ± 1.01 minutes in the nalbuphine group and 4.11 ± 0.97 minutes in the tramadol group, showing a statistically significant difference (p = 0.001).

Conclusion: Tramadol was more effective than nalbuphine in rapidly controlling shivering following spinal anaesthesia, making it a preferable option for prompt perioperative thermoregulation.

Author Biographies

  • Gul Rukh, Khyber Teaching Hospital, Peshawar, Pakistan.

    Postgraduate Resident, Department of Anesthesia, Khyber Teaching Hospital, Peshawar, Pakistan.

  • Umbrin Naz, Khyber Teaching Hospital, Peshawar, Pakistan.

    Assistant Professor, Department of Anesthesia, Khyber Teaching Hospital, Peshawar, Pakistan.

  • Romaila Mumtaz, Khyber Teaching Hospital, Peshawar, Pakistan

    Postgraduate Resident, Department of Anesthesia, Khyber Teaching Hospital, Peshawar, Pakistan

  • Parhaizgar Khan, Khyber Teaching Hospital, Peshawar, Pakistan.

    Professor and Chairman, Department of Anesthesia, Khyber Teaching Hospital, Peshawar, Pakistan.

References

Fonseca NM, Guimarães GMN, Pontes JPJ, Azi L, de Ávila Oliveira R. Safety and effectiveness of adding fentanyl or sufentanil to spinal anesthesia: systematic review and meta-analysis of randomized controlled trials. Braz J Anesthesiol. 2023;73(2):198-216.

Feng G, Wang Y, Feng J, Luo X, Li C, Yao S. The relationship between core temperature and perioperative shivering during caesarean section under intrathecal anesthesia with bupivacaine and ropivacaine: a randomized controlled study. J Anesth. 2021;35(6):889-95.

Thangavelu R, George SK, Kandasamy R. Prophylactic low dose ketamine infusion for prevention of shivering during spinal anesthesia: A randomized double blind clinical trial. J Anaesthesiol Clin Pharmacol. 2020;36(4):506-10.

Esmat IM, Mohamed MM, Abdelaal WA, El-Hariri HM, Ashoor TM. Postspinal anesthesia shivering in lower abdominal and lower limb surgeries: a randomized controlled comparison between paracetamol and dexamethasone. BMC Anesthesiol. 2021;21(1):262.

Tubog TD, Bramble RS. Ondansetron for Shivering after Spinal Anesthesia in Cesarean Delivery: A Systematic Review and Meta-analysis. J Perianesth Nurs. 2022;37(1):105-13.

Zheng G, Zhang J, Liu J, Chen C, Zhang L, Cao F. A meta-analysis of randomized controlled trials: efficiency and safety of ondansetron in preventing post-anesthesia shivering during cesarean section. Arch Gynecol Obstet. 2023;307(1):223-31.

Wang N, Wang Z, Song X, Wang J. Intravenous dexmedetomidine versus intravenous clonidine for post spinal anesthesia shivering: a meta-analysis of randomized controlled trials. Scott Med J. 2020;65(3):94-102.

Paramasivan A, Lopez-Olivo MA, Foong TW, Tan YW, Yap APA. Intrathecal dexmedetomidine and postoperative pain: A systematic review and meta-analysis of randomized controlled trials. Eur J Pain. 2020;24(7):1215-27.

Mortazavi Y, Seyfi S, Jafarpoor H, Esbakian B, Gholinia H, Esmaeili M, et al. The Effect of Warmed Serum on Shivering and Recovery Period of Patients Under General and Spinal Anesthesia: A Randomized Clinical Trial. J Perianesth Nurs. 2024;39(1):38-43.

Palanisamy S, Rudingwa P, Panneerselvam S, Satyaprakash MVS, Kuberan A, Amala R. Effect of low dose phenylephrine infusion on shivering and hypothermia in patients undergoing cesarean section under spinal anesthesia: a randomized clinical trial. Int J Obstet Anesth. 2022;50:103542.

Subramani Y, Nagappa M, Kumar K, Fochesato LA, Chohan MBY, Zhu YF, et al. Effect of intrathecal lipophilic opioids on the incidence of shivering in women undergoing cesarean delivery after spinal anesthesia: a systematic review and bayesian network meta- analysis of randomized controlled trials. BMC Anesthesiol. 2020;20(1):214.

Tao W, Xie Y, Bao J, Ding W, Zhang Y, Hu X. 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. BMJ Open. 2024;14(7):e083202.

Moheb M, Rezaei M, Azizi-Fini I, Atoof F, Saadati MA. Comparison of the Effect of Forced-air Warming and Warmed Intravenous Fluid on the Comfort and Prevention of Shivering After Spinal Anesthesia in Patients Undergoing Orthopedic Surgery. J Perianesth Nurs. 2022;37(6):865-71.

Gupta A, Angral R, Kalsotra SK, Saini H, Chander AM. Comparison of Preemptive Effect of Intravenous Ketorolac Versus Nalbuphine on Postoperative Shivering and Pain in Patients Undergoing Surgery Under Spinal Anesthesia: A Prospective, Randomized, Double-Blind Study. Asian J Anesthesiol. 2023;61(4):161-8.

Kaur H, Kaur S, Gupta KK, Singh A. Comparative Evaluation of the Intravenous Dexmedetomidine and Nalbuphine for Treatment of Post Spinal Shivering-A Randomized Prospective Trial. Asian J Anesthesiol. 2022;60(4):146-54.

Amsalu H, Zemedkun A, Regasa T, Adamu Y. Evidence-based guideline on prevention and management of shivering after spinal anesthesia in resource-limited settings. Int J General Med. 2022; 15:6985.

Renaningtyastutik Y, Lumadi SA, Handian FI. The relationship between operation duration and shivering in post-spinal anaesthesia patients. JPNS. 2022;1(3):107-14.

Tudimilla S, Suryawanshi C, SaravanKumar K. A Comparative Evaluation of Nalbuphine and Tramadol for the Control of Post-Spinal Anaesthesia Shivering. Cureus. 2021;13(12): e20481

Madem A, Parusha S, Mallem D, Pacharla I, Kotra V, Chooi WH, et al. Comparing the Effect of Intravenous Tramadol and Intravenous Nalbuphine in Addition to Midazolam for the Control of Shivering after Spinal Anesthesia. J. Pharmacol. Pharmacother. 2024;15(3):264-76.

Latif R, Nazneen Z, Khattak R, Shah AA, Siddiqi A, Aaqil B, et al. Nalbuphine and Tramadol in the treatment of post spinal anesthesia shivering: a randomized control study. Pak J Physiol. 2020;16(4):17-20.

Nirala DK, Prakash J, Ram B, Kumar V, Bhattacharya PK, Priye S. Randomized double-blinded comparative study of intravenous nalbuphine and tramadol for the treatment of postspinal anesthesia shivering. Anesth Essays Res. 2020;14(3):510-4.

Downloads

Published

2025-06-28

How to Cite

1.
Rukh G, Umbrin Naz, Romaila Mumtaz, Parhaizgar Khan. COMPARISON OF NALBUPHINE HYDROCHLORIDE AND TRAMADOL HYDROCHLORIDE FOR CONTROLLING POST-SPINAL ANESTHESIA SHIVERING. IJHR [Internet]. 2025 Jun. 28 [cited 2025 Aug. 11];3(3 (Health & Allied):809-16. Available from: https://insightsjhr.com/index.php/home/article/view/1019