Korean J Pain.  2013 Oct;26(4):379-386. 10.3344/kjp.2013.26.4.379.

Intrathecal Meperidine Plus Lidocaine for Prevention of Shivering during Cesarean Section

• Rastegarian A
• Ghobadifar MA
• Kargar H
• Mosallanezhad Z

• KMID: 2074047
• DOI: http://doi.org/10.3344/kjp.2013.26.4.379

Abstract

BACKGROUND
Shivering related to spinal anesthesia may interfere with monitoring and is uncomfortable. The aim of the present study was to investigate low-dose intrathecal meperidine for the prevention of shivering after induction of spinal anesthesia in parturients with cesarean section.
METHODS
This was a prospective randomized, double-blind, placebo-controlled trial including 100 parturients, of American Society of Anesthesiologists (ASA) physical status I or II, scheduled for elective cesarean section under spinal anesthesia who were randomly assigned to a meperidine (0.2 mg/kg) plus hyperbaric lidocaine (5%, 75 mg, n = 50; group M) group or a placebo plus hyperbaric lidocaine (5%, 75 mg, n = 50; group L) group. Demographic and surgical data, adverse events, and the mean intensity for each parturient were assessed during the entire study period by a blinded observer.
RESULTS
There were no significant differences between the two study groups regarding the demographic and surgical data (P > 0.05). The incidence of shivering during the entire study period significantly decreased in the group of parturients who received intrathecal meperidine (P = 0.04). There were no significant differences in nausea and vomiting between the two groups.
CONCLUSIONS
Low-dose intrathecal meperidine (10 mg) is safe and effective in reducing the incidence and severity of shivering associated with spinal anesthesia in parturients with cesarean section.

Keyword

cesarean; intrathecal meperidine; shivering; spinal anesthesia

MeSH Terms

Anesthesia, Spinal
Cesarean Section
Female
Incidence
Lidocaine
Meperidine
Nausea
Pregnancy
Prospective Studies
Shivering
Vomiting
Lidocaine
Meperidine

Figure

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  Fig. 1 Participation flow chart.

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  Fig. 2 Changes in mean systolic pressure between groups L and M. Each bar represents the mean ± SD. Group L (n = 50) received spinal anesthesia that consisted of hyperbaric lidocaine (5%, 75 mg) and normal saline. Group M (n = 50) received spinal anesthesia that consisted of hyperbaric lidocaine (5%, 75 mg) and meperidine (0.2 mg/kg). There were no significant differences between group L and M. *P < 0.05: Compared to pre-operative values within each group.

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  Fig. 3 Changes in mean diastolic pressure between groups L and M. Each bar represents the mean ± SD. Group L (n = 50) received spinal anesthesia that consisted of hyperbaric lidocaine (5%, 75 mg) and normal saline. Group M (n = 50) received spinal anesthesia that consisted of hyperbaric lidocaine (5%, 75 mg) and meperidine (0.2 mg/kg). There were no significant differences between group L and M. *P < 0.05: Compared to pre-operative values within each group.

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  Fig. 4 Changes in heart rate between groups L and M. Each bar represents the mean ± SD. Group L (n = 50) received spinal anesthesia that consisted of hyperbaric lidocaine (5%, 75 mg) and normal saline. Group M (n = 50) received spinal anesthesia that consisted of hyperbaric lidocaine (5%, 75 mg) and meperidine (0.2 mg/kg). There were no significant differences between group L and M.

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  Fig. 5 The incidence of shivering. The incidence of shivering was significantly lower in group M than in group L (P < 0.05).

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  Fig. 6 The intensity of shivering for each patient; 0, no shivering; 1, peripheral, piloerection vasoconstriction, or both are present but no visible shivering; 2, muscular activity in only one muscle group; 3, muscular activity in more than one muscle group but no generalized shivering (moderate muscular activity); 4, shivering involving the whole body (violent muscular activity). There were significant differences in the intensity of shivering between groups L and M (P < 0.05).

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