IntroductionShivering is among the unpleasant and potentially harmful side effects of spinal anesthesia. The aim of this randomized double-blind clinical trial was to compare the antishivering effect of two different doses of intrathecal pethidine on the incidence and intensity of shivering and other side effects in patients who underwent cesarean section.MethodsIn this study, 150 parturient females scheduled for nonemergent cesarean section were randomly allocated to three groups. Spinal anesthesia was performed with 0.5% hyperbaric bupivacaine (12.5 mg), plus 0.5 mL of 0.9% saline in the standard group (S group), and the same dose of bupivacaine with 5 mg (P5 group) or 10 mg of pethidine (P10 group). Demographic and surgical data, incidence and intensity of shivering (primary outcome), hemodynamic indices, forehead and core temperatures, maximum sensory level, Apgar scores, and adverse events were evaluated by a blinded observer.ResultsThere were no significant differences between the three study groups regarding the demographic and surgical data, hemodynamic indices, core temperatures, and maximum sensory level (P>0.05). The incidence and intensity of shivering were significantly less in the P5 and P10 groups (P<0.001) when compared with the S group. There were no significant differences between groups for secondary outcomes, except pruritus, which was more common in the P5 and P10 groups when compared with the S group (P=0.01).ConclusionLow dose of intrathecal pethidine is safe, and can decrease the incidence and intensity of shivering during cesarean section, without having major side effects.

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Spinal anesthesia (SA) may impair thermoregulatory control, which may result in shivering, which is a potentially harassing complication. The aim of the current study was to evaluate the prophylactic effects of intravenous ketamine on the prevention of shivering in patients who underwent elective cesarean section (CSs) under SA. In this double-blind, randomized placebo controlled trial, a total of 90 parturients under SA using hyperbaric bupivacaine 12.5 mg were allocated in two groups to receive ketamine 0.3 mg/kg or 0.9% saline following delivery. After induction of SA, patients were observed for the incidence and intensity of shivering using a four-point scale. Shivering was observed in 24 patients (53.3%) in the saline group and 15 patients (33.3%) in the ketamine group. Median (quartiles 1 and 3) of the intensity of shivering was 1 (0-2) and 0 (0-2) in saline and ketamine groups, respectively. Time from spinal anesthesia to the beginning of shivering was 33.1±11.7 min in saline versus 41.6±20.7 min in the ketamine group. The incidence of nausea, vomiting, hypotension, and bradycardia was not different between the groups. A significantly higher incidence of nystagmus and sedation was observed in the ketamine group when compared with the saline group administration of low dose i.v. Ketamine (0.3 mg/kg) was effective in lowering shivering intensity during CSS under spinal anesthesia, though side effects such as nystagmus and sedation may restrict its effectiveness.

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