Intrathecal Meperidine and Shivering in Obstetric Anesthesia

Yu, S. C.; Kee, Warwick D. Ngan; Kwan, Alan

doi:10.1213/01.ane.0000133960.70591.ec

Cited by 5 publications

(4 citation statements)

References 4 publications

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“…Postanesthesia shivering is probably due to redistribution of heat from core to periphery, loss of thermoregulatory vasoconstriction below the level of blockade resulting in an increased heat loss from body surfaces [12,13], and altered thermoregulation characterized by a decrease in vasoconstriction threshold [14]. Shivering causes patient distress and also leads to other adverse effects, including increased oxygen consumption, carbon dioxide, lactic acid production and increased left ventricular systolic work index [15,16]. Prevention seems essential especially in vulnerable patients and should be effective, simple, and cheap.…”

Section: Discussionmentioning

confidence: 99%

Role of intrathecal nalbuphine on prevention of postspinal shivering after knee arthroscopy

Eskandr

Ebeid

2016

Egyptian Journal of Anaesthesia

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Background: Shivering associated with spinal anesthesia is a common and uncomfortable problem and may interfere with monitoring, oxygen consumption and carbon dioxide production. The aim of the study was to evaluate the effect of intrathecal nalbuphine on the prevention of shivering during spinal anesthesia in patients undergoing knee arthroscopy. Methods: 60 patients (ASA physical status I or II) scheduled for knee arthroscopy under spinal anesthesia were randomly assigned to one of two equal groups: Group C (control group, n = 30) receiving 2.5 ml of 0.5% bupivacaine during spinal anesthesia; and Group N patients (nalbuphine group, n = 30) receiving 2.5 ml of a mixture of 400 lg nalbuphine plus 0.5% bupivacaine during spinal anesthesia. Before commencing regional anesthesia, standard monitoring was established and patients were given intravenous 15 ml/kg/h of crystalloid solution (at room temperature 23-25°C). All operations were performed in the same operating room which maintained at a constant temperature of 23-25°C and no means of active warming were used. Mean arterial blood pressure (MAP), heart rate (HR), arterial oxygen saturation (SPO2), core (tympanic) temperature, the incidence and severity of shivering were all determined and recorded at baseline and every 10 min after anesthesia till end of surgery. Results: Shivering was observed in 19 patients (63.3%) in control group and 7 patients in nalbuphine group (23.3%) with significant difference between the two groups (P = 0.004) and significant difference in intensity of shivering and core temperature (P < 0.001). No significant statistical difference was observed as regards hemodynamic parameters and oxygen saturation between the two groups. Conclusion: Intrathecal nalbuphine is an effective and safe method to prevent shivering during spinal anesthesia in patients undergoing knee arthroscopy.

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Section: Discussionmentioning

confidence: 99%

Role of intrathecal nalbuphine on prevention of postspinal shivering after knee arthroscopy

Eskandr

Ebeid

2016

Egyptian Journal of Anaesthesia

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“…Pethidine is an agonist for µ- and κ-opioid receptors; however, it seems that the higher antishivering action of pethidine is via its affinity for the κ-receptor 18 , 19 and takes place in plasma concentration of 0.6 and 1.8 µg/mL. 20 In this study, 5 or 10 mg of intrathecal pethidine was used, so it is unlikely that antishivering effects occurred via systemic absorption of pethidine.…”

Section: Discussionmentioning

confidence: 88%

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

Shami¹,

Nasseri²,

Shirmohammadi³

et al. 2016

DDDT

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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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“…Prophylaxis against shivering is very important to prevent its delirious effects, which might be harmful especially for vulnerable patients with low reserve, such as patients' discomfort, increased oxygen consumption, CO2 production and lactic acidosis (21,22) .…”

Section: Discussionmentioning

confidence: 99%

Nalbuphine Vs Midazolam for Prevention of Shivering in Patients Undergoing Lower Limb Surgery under Spinal Anesthesia; Prospective, Randomized and Double Blinded Controlled Study

Mohamed

Ali

Badawy

2021

The Egyptian Journal of Hospital Medicine

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Background: Shivering is an involuntary, repetitive contractions of skeletal muscles, which commonly occurred after spinal block and it is an uncomfortable problem to the patients and the anesthetists. Shivering is considered as a complication of anesthesia. Shivering has deleterious effects on the cardiac function especially in patients who have limited cardiopulmonary reserve and coronary disease, which could be explained by increased oxygen consumption, production of carbon dioxide and lactic acidosis caused by shivering. Objective: Our study was aiming at evaluating the effect of intrathecal nalbuphine versus intrathecal midazolam in the prevention of shivering during subarachnoid block. Patients and Methods: Ninety patients (ASA physical status I or II) scheduled for lower limb surgeries under spinal anesthesia were randomly allocated into three groups using sealed envelopes technique; Control group receiving mixture of bupivacaine and saline, Nalbuphine (N) group receiving nalbuphine and bupivacaine, and Midazolam group receiving midazolam and bupivacaine. Upon arrival to the operation room basic monitoring was applied and lactated ringer solution at room temperature was infused through peripheral venous catheter. Results: Shivering occurred in 20 patients (66.7%) in control group, 7 patients in nalbuphine group (23.3%), and 10 in midazolam group (33.3%). The incidence of shivering and core temperature differed significantly between group N and the other two groups (P values in saline and midazolam groups > 0.05, while that of nalbuphine < 0.05). Conclusion: Intrathecal nalbuphine is more effective than intrathecal midazolam in prevention of post-spinal shivering for patients undergoing lower limb surgery.

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Intrathecal Meperidine and Shivering in Obstetric Anesthesia

Cited by 5 publications

References 4 publications

Role of intrathecal nalbuphine on prevention of postspinal shivering after knee arthroscopy

Role of intrathecal nalbuphine on prevention of postspinal shivering after knee arthroscopy

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

Nalbuphine Vs Midazolam for Prevention of Shivering in Patients Undergoing Lower Limb Surgery under Spinal Anesthesia; Prospective, Randomized and Double Blinded Controlled Study

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