Use of oral tramadol to prevent perianesthetic shivering in patients undergoing transurethral resection of prostate under subarachnoid blockade

Under regional anesthesia, geriatric patients are prone to shivering induced perioperative complications that Anesthesiologists should prevent rather than treat. We investigated the prophylactic efficacy of oral tramadol 50 mg to prevent the perioperative shivering after transurethral resection of prostate [TURP] surgery under subarachnoid blockade [SAB]. Shivering is usually overlooked in patients undergoing urological surgery under spinal anesthesia and may result in morbidity, prolonged hospital stay and increased financial burden. Use of prophylactic measures to reduce shivering in geriatric patients who undergo urological procedures could circumvent this. Oral formulation of tramadol is a universally available cost-effective drug with the minimal side-effects. Prospective, randomized, double-blinded, placebo-controlled study. A total of 80 patients who were scheduled for TURP surgery under subarachnoid block were randomly selected. Group I and II [n = 40 each] received oral tramadol 50 mg and placebo tablet respectively. After achieving subarachnoid block, the shivering, body temperature [tympanic membrane, axillary and forehead], hemodynamic parameters and arterial saturation were recorded at regular intervals. T-test, analysis of variance test, Z-test and Fisher exact test were utilized while Statistical Product and Service Solutions, IBM, Chicago [SPSS statistics [version 16.0]], software was used for analysis. Incidence of shivering was significantly less in patients who received tramadol [7.5% vs. 40%; P < 0.01]. The use of tramadol was associated with clinically inconsequential side-effects. We conclude that the use of oral tramadol 50 mg is effective as a prophylactic agent to reduce the incidence, severity and duration of perioperative shivering in patients undergoing TURP surgery under SAB

comparative evaluation of intrathecal bupivacaine alone, sufentanil or butorphanol in combination with bupivacaine for endoscopic urological surgery

The objective of the present study was to compare the onset, degree and recovery time of sensory and motor block and hemodynamic effects of intrathecal bupivacaine alone and bupivacaine with sufentanil or butorphanol in endoscopic urological surgeries. In a randomized, double-blind study, 90 patients of either sex and age, belonging to ASA Grades I and II, scheduled for elective endoscopic urological surgeries under spinal anesthesia, were allocated into three groups of 30 each. Patients received either 2.5 ml of 0.5% hyperbaric buypivacaine 12.5 mg [Group A], 1.5 ml of 0.5% hyperbaric bupivacaine 7.5 mg with 10 ?g sufentanil [Group B] or 1.5 ml of 0.5% hyperbaric bupivacaine 7.5 mg with 25 ?g butorphanol [Group C]. Vital parameters, level, duration and regression of sensory block and motor block and side-effects were recorded and compared. Analysis of variance [ANOVA], post hoc test and Chi-square test were used. Intrathecal addition of sufentanil/butorphanol prolonged the duration of sensory block [DOSB] compared with bupivacaine alone [DOSB being 156.83 +/- 23.83 min, 170.87 +/- 22.21 min and 171.17 +/- 23.99 min in groups A, B and C, respectively] without altering the duration of motor blockade. Bromage score 3 was achieved in 100%, 90% and 54.4% patients in groups A, B and C, respectively. The time to first request for analgesia was 112 +/- 46.3 min, 323 +/- 65.0 min and 299 +/- 73.9 min in groups A, B and C, respectively. Complications were reduced by the addition of butorphanol, which also has a lower tendency than sufentanil to produce pruritus [60%].The analgesia was significantly prolonged in groups B and C; group C had a less-intense motor block. Complications were reduced by the addition of butorphanol, which also has a lower tendency than sufentanil to produce pruritus. Thus, this combination of butorphanol with low-dose bupivacaine is especially beneficial in the geriatric group of patients who have multiple co-morbid conditions