SummaryWe performed a prospective, randomised, double blind study to compare the antishivering effect of morphine and pethidine when added to intrathecal hyperbaric bupivacaine during elective Caesarean delivery under combined-spinal epidural anaesthesia. Spinal anaesthesia consisted of either 8-10 mg of 0.5% bupivacaine alone (group B; n = 30) with 0.1 mg morphine (group BM0.1; n = 29), with 0.2 mg morphine ( group BM0.2; n = 30), or with 10 mg pethidine (group BPeth10; n = 30). The incidences of shivering were 23.3% (7 ⁄ 30) in group B, 17% (5 ⁄ 29) in group BM0.1, 13.3% (4 ⁄ 30) in group BM0.2 and 3.3% (1 ⁄ 30) in group BPeth10 (p < 0.05). The shivering intensity for each patient was significantly higher in group B than the other groups. In conclusion, intrathecal pethidine added to hyperbaric bupivacaine reduces the incidence and intensity of shivering more than does morphine (0.1 or 0.2 mg). Shivering during neuraxial anaesthesia is a common problem that could have potentially detrimental effects such as increases in oxygen consumption, carbon dioxide production, lung ventilation, and cardiac work, as well as causing decreased mixed-venous oxygen saturation [1]. It has also been shown to increase the metabolic rate by up to 400% [2]. These effects may be particularly disturbing in mothers during labour and delivery [3].Although intravenous pethidine is widely used to treat peri-operative shivering [4-6], we found only one description in the English literature of the effect of intrathecal pethidine in preventing shivering [7]. The authors in that report found a lower incidence and severity of shivering with combined intrathecal pethidine and morphine compared to morphine alone (9 ⁄ 20 vs. 17 ⁄ 20; p < 0.02) in spinal anaesthesia using hyperbaric bupivacaine. It is also known that systemic administration of pethidine is more effective in reducing shivering than equianalgesic concentrations of pure l-receptor agonists [8,9]; however, there is no report on the antishivering effect of intrathecal pethidine compared with other opioids.This prospective, randomised, double-blind study was performed to compare the antishivering effects of morphine and pethidine added to intrathecal hyperbaric bupivacaine in patients who underwent elective Caesarean delivery under combined-spinal epidural anaesthesia. MethodAfter receiving approval from the ethics committee and informed, written consent from patients, 119 parturients (ASA physical status I or II) scheduled for elective Caesarean delivery under combined-spinal epidural anaesthesia were enrolled. Parturients with contra-indications to regional anaesthesia, allergy to the study medication, severe obesity, pre-eclampsia, placenta praevia, or diabetes were excluded. A power analysis was performed to determine a sufficient sample size required to establish a significant difference in the incidence and intensity of shivering based on the results of a preliminary study, using

Pretreatment with intravenous ketamine inhibits inflammatory pain behavior and FLI expression following a formalin injection in rats, suggesting that pretreatment of ketamine plays an important role in preemptive analgesia.

Prophylactic piroxicam patches are effective and safe for the relief of shoulder tip pain after laparoscopy. Bilateral suprascapular nerve block is not effective in this setting.