Efficacy of prophylactic epidural ketamine for reducing shivering in patients undergoing caesarean section with combined spinal‑epidural anesthesia

Abstract

Abstract.Intravenous ketamine is known to inhibit postoperative shivering; however, at present, there has been little research on whether this effect may be achieved with epidural application. The aim of the present study was to evaluate the efficacy and safety of epidural ketamine as a prophylactic agent to prevent shivering in patients undergoing caesarean section during combined spinal-epidural anesthesia. A prospective, randomized, double-blind study was performed. A total of 60 patients who were undergoing elective caesarean section under combined spinal-epidural anesthesia and had an American Society of Anesthesiologists physical status of I or II were recruited. Patients were randomly allocated to group S (epidural administration of normal saline; n=30) or group K (epidural ketamine 0.5 mg/kg; n=30). An investigator, blinded to the treatment groups, graded postoperative shivering using a 4-point scale and postoperative sedation on a 5-point scale. Operative time, hemodynamic changes and side effects, including hypotension, bradycardia, nausea and hallucinations, were recorded. The results demonstrated that patients' characteristics were not significantly different between groups. Heart rate, peripheral capillary oxygen saturation (SpO 2 ) values and Apgar scores at 1 and 5 min also did not differ significantly between groups. The incidence and severity of shivering in group K was significantly reduced compared with group S (P<0.05). The mean arterial pressure (MAP) was significantly different in groups S and K compared with baseline values at 10, 30 and 60 min (P<0.05). Furthermore, MAP values at 10, 30 and 60 min were significantly higher in group K compared with in group S (P<0.05). The results of the present study suggest that epidural administration of prophylactic low-dose ketamine may be an effective strategy for preventing postoperative shivering.

Comparison of Intravenous Ketamine with Intrathecal Meperidine in Prevention of Post-anesthetic Shivering after Spinal Anesthesia for Lower Limb Orthopedic Surgeries: A Double-blind Randomized Clinical Trial

“…The results of a study showed the prophylactic effect of ketamine for postoperative shivering after general anesthesia ( 23 , 24 ). Another study confirmed the safety and prophylactic efficacy of epidural ketamine for prevention of shivering in patients undergoing caesarean section during combined spinal epidural anesthesia ( 25 ). In comparison of two doses of 0.5 and 0.3 mg/kg of intravenous ketamine, the results of a similar study in Iran showed that ketamine at a dose of 0.5 mg/kg has a significant effect on reducing postoperative shivering compared to the dose of 0.3 mg.…”

Control of Shivering with Prophylactic Ketamine During Subarachnoid Block: A Placebo-Controlled Randomised Double- Blind Study

“…The frequency of nausea and hypotension (systolic pressure, <90 mmHg) was significantly higher in group S (epidural administration of normal saline; n=30) compared with group K, (epidural ketamine 0.5 mg/kg; n=30). 26 Our study saw that ketamine at a dose of 0.5 mg /kg and ketamine at dose of 0.25 mg /kg have a significant effect in prevention of shivering in the patients undergoing elective infra-umbilical surgery under subarachnoid blocks. Lema, GF et al 27 , determined in their study that incidence of shivering was significantly reduced in the ketamine group (41.5%) compared to the saline group (70.7%; p=0.028) and prophylactic administration of low-dose IV ketamine is effective for reducing the incidence and intensity of shivering and can be recommended for patients undergoing cesarean section under spinal anaesthesia.…”

“…Lema, GF et al 27 , determined in their study that incidence of shivering was significantly reduced in the ketamine group (41.5%) compared to the saline group (70.7%; p=0.028) and prophylactic administration of low-dose IV ketamine is effective for reducing the incidence and intensity of shivering and can be recommended for patients undergoing cesarean section under spinal anaesthesia. Similarly, the study by Hasannasab, B et al 21 , and Xue, X et al 26 , also showed that ketamine is effective in the prevention of postoperative shivering. In summary, the results of the present study suggest that prophylactic epidural administration of low-dose ketamine is able to reduce the incidence and severity of shivering in patients undergoing elective infra-umbilical surgery under subarachnoid blocks.…”

The Non-Pharmacological Management of Shivering Post-Spinal Anesthesia

“…24 Insiden shivering setelah anestesi spinal atau epidural telah dilaporkan menjadi 45% hingga 85%. 25 Perbedaan pada anestesi umum dan anestesi spinal yang paling nyata adalah cara tubuh mengkompensasi hipotermia. Pada anestesi umum, blok terjadi pada seluruh tubuh sehingga vasodilatasi terjadi pada seluruh tubuh.…”