Intravenous Meperidine for Control of Shivering During Caesarean Section Under Epidural Anaesthesia

Casey, William; Smith, C. E.; Katz, J. M.; OʼLoughlin, K.; Weeks, Sally K.; Ansley, David M.; McMorland, G. H.

doi:10.1097/00132582-198810000-00031

Cited by 8 publications

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“…It has also been shown to control shivering in patients undergoing Caesarean section under extradural anaesthesia, by either i.v. [27] or extradural routes [28]. After general anaesthesia, Claybon and Hirch [13] reported that, after general anaesthesia, pethidine 25 mg arrested shivering within 5 min in 73 % of patients.…”

Section: Resultsmentioning

confidence: 99%

Double-Blind Comparison Between Doxapram and Pethidine in the Treatment of Postanaesthetic Shivering

Singh

Dimitriou

Mahajan

et al. 1993

British Journal of Anaesthesia

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Sixty patients who shivered after routine surgery under general anaesthesia were allocated randomly to receive normal saline (n = 20), doxapram 1.5 mg kg-1 (n = 20) or pethidine 0.33 mg kg-1 (n = 20). Both doxapram and pethidine were effective in treating postoperative shivering 2-3 min after i.v. administration. In the group who received normal saline, 15 patients were still shivering 10 min after treatment, whilst in the doxapram group only three patients were shivering at that time. In the pethidine group, all patients had stopped shivering by 7 min after treatment. We conclude that both doxapram and pethidine were effective in the treatment of postoperative shivering.

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Section: Resultsmentioning

confidence: 99%

Double-Blind Comparison Between Doxapram and Pethidine in the Treatment of Postanaesthetic Shivering

Singh

Dimitriou

Mahajan

et al. 1993

British Journal of Anaesthesia

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“…P OST‐ANESTHETIC shivering is a common problem in the recovery room, with potentially detrimental effects including increased oxygen consumption, carbon dioxide production, minute ventilation, and cardiac output as well as decreases in mixed venous oxygen saturation and ability to measure hemoglobin oxygen saturation via peripheral pulse oximetry ( 1). Pethidine has been shown to be one of the most effective treatments for post‐anesthetic shivering ( 2–6). Although its mechanism of action is not completely understood, a study using naloxone indicated that pethidine may act via kappa rather than mu opioid receptors.…”

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confidence: 99%

Comparison between pentazocine, pethidine and placebo in the treatment of post‐anesthetic shivering ^Note

Terasako

Yamamoto

2000

Acta Anaesthesiol Scand

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“…While the mechanism of action is not fully understood, the anti-shivering effect of intravenous meperidine is attributed to its role in decreasing the shivering threshold due to its effect on the Kappa opioid receptor. 26,[52][53][54][55] Possible suggested mechanisms for the anti-shivering effect of meperidine include k-opioid receptor activity, anticholinergic action, biogenic monoamine reuptake inhibition, NMDA receptor antagonism, or stimulation of alpha 2adrenoceptors, and possibly modulating the heat loss caused by vasodilatation after spinal anesthesia. 54,[56][57][58] Meperidine slightly increases the threshold for sweating, signi cantly decreases the threshold for vasoconstriction, and reduces the threshold for shivering.…”

Section: Discussionmentioning

confidence: 99%

Effect of Intrathecal Lipophilic Opioids on the Incidence of Shivering in Women Undergoing Cesarean Delivery after Spinal Anesthesia: A Systematic Review and Bayesian Network Meta- analysis of Randomized Controlled Trials.

Subramani¹,

Nagappa

Kumar

et al. 2020

Preprint

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Background: Shivering is a common side effect in women having cesarean delivery (CD) under spinal anesthesia, which can be bothersome to the patient, and it can also interfere with perioperative monitoring. In several studies, the intrathecal (IT) addition of a lipophilic opioid to local anesthetics has been shown to decrease the incidence of shivering.Objective: We performed this network meta-analysis to evaluate the effects of intrathecal lipophilic opioids in preventing the incidence of shivering in patients undergoing CD. Methods: This review was planned according to the PRISMA for Network Meta-Analysis (PRISMA-NMA) guidelines. An English literature search of multiple electronic databases was conducted. We included randomized controlled trials (RCTs) that reported on the incidence of shivering, with study groups receiving either IT fentanyl, sufentanil, or meperidine in women undergoing CD under spinal anesthesia. Quality of the studies was assessed using the modified Oxford scoring system. Using random-effects modeling, dichotomous data were extracted and summarized using odds ratio (OR) with a 95% credible interval (CrI). Statistical analysis was conducted using R studio version 1.0.153 - Inc. Results: Twenty-one studies consisting of 1433 patients (Control group: 590 patients in twenty-one studies; Fentanyl group:199 patients in seven studies; Sufentanil group: 156 patients in five studies; Meperidine group: 488 patients in ten studies) met the inclusion criteria for this systematic review investigating the effect of intrathecal lipophilic opioids in preventing the incidence of shivering in women undergoing cesarean delivery under spinal anesthesia. Methodological validity scores ranged from 3 to 7. The Bayesian mixed network estimate showed the incidence of shivering was significantly lower with IT fentanyl (pooled odds ratio (OR): 0.13; 95% credible interval (CrI): 0.04 to 0.35; P = 0.0004) and IT meperidine (OR: 0.12; 95% CrI: 0.05 to 0.29; P < 0.00001), but not with IT sufentanil (OR: 0.37; 95% CrI: 0.11 to 1.22; P = 0.23). The IT fentanyl group had a significantly lower incidence of intraoperative discomfort [Risk Ratio (RR): 0.19; 95% CI: 0.10-0.35; P < 0.00001], the IT sufentanil group had a significantly higher incidence of pruritus (RR: 6.18; 95% CI: 1.18-32.46; P = 0.03) The IT meperidine group had a significantly lower incidence of intraoperative discomfort (2.7% vs. 13.6%; RR: 0.22; 95% CI: 0.09-0.55; P = 0.001), but there was a significant increase in nausea and vomiting (IT meperidine group vs. Control group: 42.7% vs. 19.4%; RR: 2.56; 95% CI: 1.14-5.75; P = 0.02). Meta-regression analysis based on the opioid dose and quality of the study did not impact the final inference of our result. Conclusion: IT fentanyl significantly decreased the incidence of shivering in women undergoing CD under spinal anesthesia without increasing maternal adverse events, confirming that routine use in this patient population is a good choice. IT sufentanil did not decrease the incidence of shivering. IT meperidine decreased the incidence and severity of shivering, but its use was also associated with significant nausea and vomiting.

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Intravenous Meperidine for Control of Shivering During Caesarean Section Under Epidural Anaesthesia

Cited by 8 publications

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Double-Blind Comparison Between Doxapram and Pethidine in the Treatment of Postanaesthetic Shivering

Double-Blind Comparison Between Doxapram and Pethidine in the Treatment of Postanaesthetic Shivering

Comparison between pentazocine, pethidine and placebo in the treatment of post‐anesthetic shivering ^Note

Effect of Intrathecal Lipophilic Opioids on the Incidence of Shivering in Women Undergoing Cesarean Delivery after Spinal Anesthesia: A Systematic Review and Bayesian Network Meta- analysis of Randomized Controlled Trials.

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Intravenous Meperidine for Control of Shivering During Caesarean Section Under Epidural Anaesthesia

Cited by 8 publications

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Double-Blind Comparison Between Doxapram and Pethidine in the Treatment of Postanaesthetic Shivering

Double-Blind Comparison Between Doxapram and Pethidine in the Treatment of Postanaesthetic Shivering

Comparison between pentazocine, pethidine and placebo in the treatment of post‐anesthetic shivering Note

Effect of Intrathecal Lipophilic Opioids on the Incidence of Shivering in Women Undergoing Cesarean Delivery after Spinal Anesthesia: A Systematic Review and Bayesian Network Meta- analysis of Randomized Controlled Trials.

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Comparison between pentazocine, pethidine and placebo in the treatment of post‐anesthetic shivering ^Note