Efficacy of Nalbuphine, Tramadol and Pethidine for Control of Shivering in Post Subarachnoid Block in Lower Limb and Lower Abdominal Surgeries - A Comparative Study

Abstract

Introduction: Spinal anesthesia is one of the most commonly used anesthetic techniques for lower abdominal and lower limb surgeries. Post-spinal shivering is a frequent complication, which can adversely affect patient comfort and recovery, as well as increase metabolic demand and oxygen consumption.

Objective: To assess and compare the clinical efficacy of intravenous nalbuphine, tramadol, and pethidine in the management of post-spinal anesthesia shivering.

Materials and Methods: A comparative observational study was conducted on 210 patients undergoing elective lower limb and lower abdominal surgeries under subarachnoid block. Patients were randomized into three groups: Group T (Tramadol 0.5 mg/kg IV), Group P (Pethidine 0.5 mg/kg IV), and Group N (Nalbuphine 0.05 mg/kg IV). The time of onset and cessation of shivering, recurrence, and adverse effects were recorded. Data was entered in Microsoft Excel and analyzed using SPSS version 22.

Results:  The mean age of patients in Group T, Group P, and Group N was 41.7, 41.9, and 44.6 years, respectively. ASA I and ASA II patients comprised 52.2% and 47.3% of the study population, with groups being comparable in terms of age, gender distribution, ASA grading, and BMI.
 The mean time to cessation of shivering was shortest with Pethidine (3.1 ± 0.4 min), followed by Tramadol (5.01 ± 0.4 min) and Nalbuphine (5.2 ± 0.48 min), which was statistically significant (p < 0.05). Shivering recurrence was most common in the Pethidine group (24.6%), compared to Tramadol (14.4%) and Nalbuphine (15.9%). Adverse effects varied across groups: 46.3% of patients in the Tramadol group experienced nausea or vomiting, while none in the Nalbuphine group had vomiting. Respiratory depression was observed in 13% of patients in the Pethidine group. Sedation scores were significantly higher with Nalbuphine, where 86.9% of patients exhibited Ramsay sedation score 3, compared to lower sedation scores with Tramadol and Pethidine.

Conclusion: All three drugs—Nalbuphine, Tramadol, and Pethidine—were effective in treating post-spinal anesthesia shivering. However, Pethidine had the fastest onset of action but showed higher recurrence and respiratory depression. Tramadol was associated with more gastrointestinal side effects, while Nalbuphine provided better sedation with minimal adverse effects. Choice of agent should be tailored to individual patient needs and clinical context.