Comparison of efficacy between nalbuphine, tramadol, and ondansetron in treatment of postanesthetic shivering after intrathecal morphine for Cesarean delivery

Abstract

Objective: To compare the efficacy between 0.05 mg/kg nalbuphine, 0.5 mg/kg tramadol and 0.1 mg/kg ondansetron, in treatment of postanesthetic shivering in cesarean section patients after intrathecal morphine. Design: Randomized double-blind controlled trial. Setting: King Chulalongkorn Memorial hospital, which is the tertiary care center. Method: Two hundred and twenty five parturients who have moderate to severe shivering were randomly allocated into 3 groups by simple randomization. Group 1 received 0.05 mg/kg nalbuphine, group 2 received 0.5 mg/kg tramadol, and group 3 received 0.1 mg/kg ondansetron. The success rate of treatment and other adverse effects were determined at 15 minutes after study drug administration. The patient satisfaction was also evaluated within 24 hours after operation. Result: The success rate of treatment of shivering in nalbuphine, tramadol, and ondansetron groups were 81.3%, 88.2% and 62.2% respectively (p-value<0.001). The success rate between nalbuphine and ondansetron groups, tramadol and ondansetron groups were statistically significant different (p-value = 0.009 and p-value < 0.001 respectively). The success rate between nalbuphine and tramadol groups was not statistically significant different (p-value = 0.243). The recurrence rate of moderate to severe shivering within 4 hours after first successful treatment in nalbuphine, tramadol, and ondansetron groups were 14.8%, 13.4%, and 13.0% respectively, which were not statistically significant different (p-value = 0.963). Other side effects such as pruritus, sedation, nausea, vomiting, pain, and dizziness were not significantly different. The patient satisfactions with the care provided by the Department of Anesthesiology in general among three groups were not statistically significant different (p-value = 0.953). But the patient satisfactions regarding treatment of shivering in nalbuphine and tramadol groups were statistically significantly greater than in ondansetron group (p-value = 0.002 and p-value < 0.001 respectively). Conclusion: Nalbuphine 0.05 mg/kg and tramadol 0.5 mg/kg were more efficacious than 0.1 mg/kg ondansetron in treatment of postanesthetic shivering after intrathecal morphine for cesarean section patients with few and minor side effects. The patient satisfaction score concerning treatment of shivering in nalbuphine and tramadol groups were also higher than in ondansetron group.