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CESAREAN SECTION: THE EFFECT OF INTRATHECAL MEPERIDINE ON SHIVERING.

Département D'anesthésiologie Hôpital Maisonneuve-Rosemont, 5415 boul l'Assomption, Montréal, QC, H1T 2M4

INTRODUCTION

The use of meperidine, I.V. or I.M., to treat shivering following spinal anesthesia has been described (1). The aim of our study was to determine if prophylactic intrathecal meperidine could lower the incidence of shivering and its intensity in patients operated for cesarean section (C/S).

METHODS

After ethic committee approval and written informed consent, forty patients scheduled for non-emergent C/S, were enrolled in a randomized, controlled and double blind study. Both groups received bupivacaine 0.75% (10.5mg), morphine (0.15mg) and either meperidine (0.2mg/kg, group E, n=20) or an equivalent volume of normal saline (group C, n=20). Data collection, including sensory blockade level, arterial pressure, core temperature and shivering intensity was made q 1 min for 10 min, q 3 min for 33 min and q 5 min until the sensory level receded to L4. Sensory and motor blockade regression were compared with survival curves followed with logrank tests. Blood pressures measurements were compared with repeated measures ANOVA and shivering intensity analyzed with a chi-square test.

RESULTS

There was no difference between groups with regard to demographic data, duration of surgery and APGAR scores. Time to highest sensory level, maximum number of blocked segments, sensory and motor blockade regression (Fig 1 & 2) and systolic BP showed no difference between the groups. No patient had inadequate surgical anesthesia. The incidence (group C: 17/20, group E: 9/20) and intensity (Fig 3) of shivering was significantly less (p< 0.02) in group E.

View larger version (20K): [in this window] [in a new window]   Figure 1. Sensory blockade regression

View larger version (20K): [in this window] [in a new window]   Figure 2. Motor blockade regression

View larger version (38K): [in this window] [in a new window]   Figure 3. Shivering Intensity

Meperidine is unique among opioids in its ability to terminate or attenuate shivering in approximately 70 to 80 percent of patients. Our study shows that intrathecal meperidine can prevent shivering associated to C/S. The mechanism is unclear.

CONCLUSION

Intrathecal meperidine (0.2 mg/kg) is effective in reducing the incidence and intensity of shivering related to spinal anesthesia for C/S. The lowering of the incidence and intensity of shivering we have encountered makes meperidine a worthwhile addition to spinal anesthesia for C/S.

REFERENCES

1 Hu LH, Chen JC, Lee Y, Lai KB, Wong KL, Wei TT. [Intramuscular meperidine for the prevention ofshivering in spinal anesthesia].Ma Tsui Hsueh Tsa Chi1992;30:223–8

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