COMPARISON OF NALBUPHINE AND TRAMADOL FOR PREVENTION OF POST-SPINAL SHIVERING IN PATIENTS UNDERGOING LOWER LIMB SURGERIES
TL;DR
Tramadol demonstrated a shorter mean time to cessation of shivering, whereas nalbuphine showed a comparatively better adverse effect profile with less nausea and vomiting, which ensured adequate hemodynamic stability and are suitable for clinical use.
Abstract
Objective: This study aimed to compare the effectiveness and safety of intravenous nalbuphine and intravenous tramadol in controlling post-spinal shivering in patients undergoing lower limb surgeries under spinal anesthesia. Methods: This was a prospective, randomized, double-blind comparative study of 80 patients undergoing lower limb surgeries under spinal anesthesia from February 2025 to January 2026. The patients who had Wrench Grade III or IV shivering were randomly divided into two groups of 40 patients each. Group N was given intravenous nalbuphine 0.05 mg/kg, and Group T was given intravenous tramadol 1 mg/kg. The main outcome measured was time to cessation of shivering. Secondary outcomes were recurrence of shivering, need for rescue medication and adverse effects. Results: Group T had a significantly shorter time to stop shivering than Group N (3.54±1.46 min vs. 4.58±1.52 min; p=0.02). Of the patients in Groups T and N, respectively, 92.5% and 87.5% were successfully controlled within 5 min, with 20% and 10% experiencing recurrence of shivering. There were more cases of nausea (17.5%) and vomiting (10%) reported in the tramadol group, and relatively more cases of sedation (10%) in the nalbuphine group. Conclusion: Both nalbuphine and tramadol were effective in controlling post-spinal shivering. Tramadol demonstrated a shorter mean time to cessation of shivering, whereas nalbuphine showed a comparatively better adverse effect profile with less nausea and vomiting. Both drugs ensured adequate hemodynamic stability and are suitable for clinical use.