Evaluating The Effectiveness of Nefopam Versus Tramadol in Treating Established Post-Spinal Anesthesia Shivering: A Systematic Review
DOI:
https://doi.org/10.36283/ziun-pjmd14-2/066Keywords:
Shivering, Anesthesia, Nefopam, Tramadol, Patient Safety, Systematic ReviewAbstract
Background: Post-spinal anesthesia shivering (PSAS) was observed as a frequent and distressing complication, affecting 40–70% of patients and increasing metabolic demand. Nefopam and tramadol were two pharmacological agents for managing PSAS. Each had its distinct efficacy and side effect profiles. This study evaluated and compared the efficacy, safety, and practicality of nefopam and tramadol in the treatment of established PSAS.
Methods: A systematic review was conducted that adhered to PRISMA guidelines. The search was taken place using PubMed, ScienceDirect, and Google Scholar. Inclusion criteria focused on randomized controlled trials and observational studies published between January 2013 and April 2024. The studies were excluded if they were not based on tramadol and nefopam’s therapeutic effect on PSAS. Data for systematic review table were extracted from 16 studies evaluating sedation quality, recovery time, adverse events, and key findings. The Cochrane risk of bias tool was used for RCTs and Newcastle Ottawa tool was used for observational studies to asses risk of bias. Sedation quality was assessed by visual analog scale (VAS).
Results: Out of 110 initially selected studies, 16 were filtered out that aligned completely with the concept of this systematic review. Both nefopam and tramadol effectively were shown to reduce PSAS. Tramadol demonstrated a slightly higher efficacy (90–97%) compared to nefopam (85–90%). Tramadol, due to its rapid onset (30–60 minutes) and faster recovery times, was suitable for time-sensitive cases. However, tramadol had a higher incidence of gastrointestinal side effects (nausea and vomiting: 5–11%). In contrast, nefopam, while slower in showing effect, exhibited minimal sedation and fewer side effects but occasionally caused tachycardia and hypertension.
Discussion: Both agents were effective for PSAS management. Tramadol was preferred for rapid control and cost-friendly settings, whereas nefopam was safer for patients who required minimal sedation or who at risk of gastrointestinal side effects. However, there was no direct comparison of nefopam with tramadol. Future studies should focus on using standardized protocols and should provide direct comparison of tramadol with nefopam.
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