Comparion Of Scopolamine And Tramadol In Abating Shiver After Intrathecal Anesthesia

Objective: Shivering is a compensation to hold body temperature by rhythmic musculi skeleti contraction and vasocontriction .Intrathecal anesthesia can block adrenergic nerve which can lead to vasodilatation and increase body heat loss. Motor nerve can be blocked in intrathecal anesthesia, too, which will diminish muscular movement and tension, decrease heat production and aggravate hypothermy. According to Sessler's report, 0.5℃descent of central temperature will lead to shivering .Incidence rate of shivering in intrathecal anesthesia can be as high as 60%. The medicine which can cure shivering in intrathecal anesthesia has been being searched all the time. Many medicines can be used to prevent and treat shiver, such as alkamines,choline analogs,endorphins, et al. These medicines have different mechanisms with both advantages and disadvantages. Both scopolamine and tramadol are commonly used medicines to treat shivering. Scopolamine is a kind of M-cholinergic receptor blocker and tramadol is non-opioid paregoric alkamines. There are few articles about the comparison of the effect of the two drugs in shivering control. The purpose of this research is to compare such effect in scopolamine and tramadol and to guide clinical medication.Methods:Sixty patients with ASAⅠ~Ⅲwere selected who underwent surgeries in perineal and hypogastric region in intrathecal anesthesia. The patients were divided into three groups randomly: group T (tramadol) , group S (scopolamine) and group C (control). Patients were given the injection of 1mg/kg tramadol (group T), 0.01mg/kg scopolamine (group S) (both tramadol and scopoline were diluted to 5ml with normal saline) and 5ml normal saline (group C) in 15 seconds. SBP, DBP, MAP, HR, SpO2, shivering grading , calm degree and whether there was nausea and vomitting or not were recorded at different points of pre-anesthesia, 5 minutes after anesthesia, 3 minutes after shivering, 1, 3, 5, 10, 20 and 30 minutes after injection, as well as RPP (RPP=HR*SBP). All the data were shown in the form of X±S, and processed with SPSS 10.0(statistical package for social science) statistical software. T test was performed to get the variation between and within different groups.Result: (1)Heart rate: Shivering accelerated HR to the extent of 10%~14.6% after anesthesia. After medication, heart rate in group S was faster than both group C (4.0%~12.7%) and group S (13.2%~21.5%). HR in group T was slower than that in group C (2.3%~9.5%). (2)Shivering and the medicines don't have significant influence on BP.(3)Shivering grading: group T < group S < group C. Compared with group C, there was significant deviation in group T in 1, 3, 5, 10, 20, 30 minutes after medication (P<0.05),and in group S there was significant deviation in 3, 5, 10, 20, 30 minutes after medication (P<0.05),too. The variation was significant with shivering grading in group T compared with group C (P<0.05) at every ponit after medication. (4)RPP:RPP of three groups became obsvious higher after anesthesia. RPP of group S was higher than group C . RPP of group T was lower than group C .(5) There was no decease in SpO2 , nausea and vomitting in group T. Six patients (30%)got sensation of dizziness, with Ramsay grade score 2~3. There was no decease in SpO2 , nausea and vomitting in group S, either. But 17 patients(85%)got dry mouth, 4 patients (20%) had flushing with Ramsay grade score 3~4. 10 patients (50%) got drowsiness and 6 patients (30%) got temporal fever.Conclusion: Both 1.0mg/kg tramadol and 0.01mg/kg scopolamine which were diluted to 5ml with normal saline could be effective in treating shivering in intrathecal anesthesia. Compared with scopolamine, tramadol could exert quicker and more obvious effects and reduce MVO2 with lower recurrence and less side effects.