Effect of low dose of intrathecal pethidine on the incidence and intensity of shivering during cesarean section under spinal anesthesia: a randomized, placebo-controlled, double-blind clinical trial

Abstract

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.

Preventing shivering with adjuvant low dose intrathecal meperidine: A meta-analysis of randomized controlled trials with trial sequential analysis

“…Published from1984 to 2016, the characteristics of the 28 RCTs with 2216 participants were shown in Table 1 16 , 25 – 33 , 42 – 59 . Three studies were published in Korean 51 , 53 , 56 , two were in traditional Chinese 33 , 49 , and two were in simplified Chinese 42 , 43 , one was in Turkish 50 , and the remaining 20 were published in English.…”

“…The sample sizes ranged from 40 to 195 patients. There are 15 RCTs of obstetric patients receiving caesarean section surgery 25 , 27 – 29 , 31 , 32 , 42 , 43 , 48 , 52 , 53 , 56 – 59 , 4 trials enrolled urological surgery 16 , 44 , 47 , 55 , and the other 9 focused on lower abdominal or lower limb surgery 26 , 30 , 33 , 45 , 46 , 49 – 51 , 54 . Intrathecal local anaesthetics plus meperidine group was compared with the same dose local anaesthetics alone 16 , 25 , 28 , 42 , 43 , 49 or with normal saline 26 , 27 , 29 – 32 , 44 – 48 , 50 – 59 or with 10% glucose water 33 as controls.…”

Comparison of the Effects of Intrathecal Meperidine and Morphine on Incidence and Intensity of Shivering After Caesarean Sections Under Spinal Anesthesia: A Randomized Controlled Trial

“…Anti-shivering effect of IV meperidine is well known, so that intravenous infusion of meperidine is considered as the gold standard for treatment of shivering (3,17). Presumably this feature of meperidine is mediated by activating a kapa-opioid receptor, anticholinergic action, inhibition of biogenic monoamine reuptake, antagonism of NMethyl-D-aspartate receptor (NMDAR), and stimulation of α2-adrenoceptors (18,19).…”

“…Due to many advantages of neuraxial anesthesia for both mother and neonates, in comparison with general anesthesia, it is a more preferred method for cesarean delivery (1), however it causes impairment in the thermoregulatory function of the autonomic system and results in shivering (2,3).…”

“…One of the known effects of intrathechal opioids is the prevention and treatment of postoperative shivering (3,5,7). However, the safety of this practice is not completely stabilized.…”