Effects of Intrathecal Meperidine on Prevention of Shivering during Spinal Anesthesia for Herniorrhaphy

Abstract

Background: Shivering associated with spinal anesthesia is uncomfortable to the patient and may interfere the monitoring of patient. Hence, we have investigated whether intrathecal meperidine could decrease the incidence and intensity of shivering during spinal anesthesia for unilateral herniorrhaphy.Methods: Forty ASA class 1 or 2 patients undergoing unilateral herniorrhaphy were randomly allocated into two groups (group C and M). The patients of group C (n = 20) received hyperbaric bupivacaine (0.5%; 13 mg) and normal saline (0.004 ml/kg), and the patients of group M (n = 20) received hyperbaric bupivacaine (0.5%; 13 mg) and meperidine (0.2 mg/kg). After spinal block, the incidence and intensity of shivering were determined objectively by observing involuntary muscle activity. The measurement of the mean arterial pressures and heart rates of the patients, for every two minutes for ten minutes, and subsequently for every five minutes for thirty minutes were carried out. We have also checked the highest sensory block level, and other side effects.Results: There were no significant differences in age, height, weight and duration of surgery between the two groups. Also, the mean arterial pressures, heart rates, and the highest sensory block levels exhibited no differences between the two groups. But, the incidence and intensity of shivering in group M were significantly less than in group C (P ＜ 0.05).Conclusions: Intrathecal meperidine (0.2 mg/kg) was effective in reducing the incidence and intensity of shivering associated with spinal anesthesia for herniorrhaphy. (Korean J Anesthesiol 2005; 49: 484∼9)

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.…”

“…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.…”

“…In terms of the intrathecal local anaesthetic drug, bupivacaine was used in 21 studies 25 – 28 , 30 – 32 , 42 – 46 , 48 , 50 – 54 , 56 , 57 , 59 , lidocaine in 5 trials 16 , 29 , 47 , 55 , 58 , and tetracaine in 2 RCTs 33 , 49 . Intravenous sedation was combined with spinal anaesthesia in 4 studies 16 , 49 , 51 , 54 , and prehydration was neither given nor disclosed in 4 trials 16 , 45 , 51 , 54 . Ten RCTs did not provide information on hypothermia prevention 31 – 33 , 45 , 47 , 50 , 52 – 54 , 58 .…”

Efficacy of intrathecal dexmedetomidine in prevention of shivering in patients undergoing transurethral prostatectomy: A randomized controlled trial

“…With internal redistribution of heat from the core to the peripheral compartment, the loss of thermoregulatory vasoconstriction results in increased heat loss from body surfaces in excess of metabolic heat production [5]. Shivering causes patient discomfort, interruption of monitoring, increases O 2 consumption, CO 2 production, and catecholamine secretion that increase cardiac output, heart rate, and blood pressure [6].…”

Efficacy of granisetron on prevention of shivering, nausea and vomiting during cesarean delivery under spinal anesthesia: A randomized double-blinded clinical trial

“…[5] Perioperative hypothermia and shivering are usually prevented by physical methods like surface warming and pharmacologically by drugs such as pethidine, tramadol, clonidine, and ketamine. [6][7][8][9] Serotonin (5-hydroxytryptamine ), a biologic amine found in the brain and spinal cord, plays a part in neurotransmission; studies suggest that the serotonergic system plays a role in controlling perioperative shivering. A serotonin 5-HT3 receptor antagonist inhibits the uptake of serotonin in the preoptic anterior hypothalamic region, which influences both heat production and heat loss.…”