Evaluating the Effectiveness of Nefopam Versus Tramadol in Treating Established Post-Spinal Anesthesia Shivering: A Systematic Review
Bibliographic record
Abstract
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 took 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 the 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 the Newcastle Ottawa tool was used for observational studies to assess the risk of bias. Sedation quality was assessed by a 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 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 were 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 a direct comparison of tramadol with nefopam.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.010 | 0.038 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.012 | 0.011 |
| Bibliometrics | 0.010 | 0.008 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".