الفهرس 
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Abstract
P
ost-anesthetic shivering refers to spontaneous, involuntary, rhythmic, oscillating and tremor-like muscle hyperactivity that increases metabolic heat production up to 600% after general or regional anesthesia.
Shivering is not only subjectively unpleasant but is physiologically stressful because it elevates blood pressure, heart rate, oxygen consumption, and plasma catecholamine concentrations. Moreover, shivering may aggravate pain and hinder wound closure by simply stretching surgical incisions.
The mechanism for shivering after spinal anesthesia may be related to disruption of normal temperature regulation resulting from the re-distribution of body heat from the center of the body to the periphery. As a result, the afferent temperature signal in the anesthetized area is not transmitted to the thermoregulation center located in the hypothalamus.
The aim of this work was to compare the efficacy of intravenous tramadol VS nalbuphine for prevention of post spinal shivering during knee arthroscopy.
This prospective randomized double blinded study was carried out in Ain Shams University hospitals on 90 patients scheduled for knee arthroscopy. Patients were randomized into three groups 30 patients each:
group T: Patients received Tramadol 0.5 mg/kg intravenously. group N: Patients received nalbuphine 0.1mg/kg intravenously. group C: patients received normal saline 0.9%) intravenously.
All drugs were given immediately after intra thecal injection of the anaesthetic drugs and returning to the supine position.
Comparisons were done between the three groups as regards: incidence of shivering, onset and grade of shivering, hemodynamics (MAP, HR, temperature, respiratory rate, oxygen saturation) sedation scores, and the incidence of nausea and/or vomiting.
The study revealed that the incidence of shivering was less in the tramadol (23.3%) and nalbuphine (26.7%) groups compared to the control group (76.7%) (P<0.05) with no significant difference between Nalbuphine and Tramadol groups (p >0.05). As regard grade of shivering; there was significant difference between both tramadol, nalbuphine groups compared to the control group, there was no significant difference between tramadol and nalbuphine groups.
There was no significant differences among the three groups as regards hemodynamics (Heart rate and mean blood pressure), respiratory rate, oxygen saturations, body temperature, the incidence of nausea or vomiting (P>0.05).
Regarding to the side effects (nausea, vomiting and sedation) there was significant difference between both of tramadol and nalbuphine groups compared to the control group with no significant difference between tramadol and nalbuphine groups.
The current study revealed that both tramadol 0.5mg/kg and nalbuphine 0.1mg/kg were effective in prevention of post spinal shivering in patients undergoing knee arthroscopy.