Pre-induction low dose pethidine does not decrease incidence of postoperative shivering in laparoscopic gynecological surgeries

Abstract

Objectives:The incidence of shivering in patients undergoing a laparoscopic procedure is stated to be about 40%. A majority of laparoscopic gynecological procedures are taken up on an outpatient basis. Postoperative shivering may delay hospital discharge and is a common cause of discomfort in patients recovering from anesthesia.Aims:To determine the effect of pre-induction, low-dose pethidine on postoperative shivering in patients undergoing laparoscopic gynecological surgeries.Setting and Design:Sixty females between 25 and 35 years of age, of American Society of Anesthesiologists (ASA) class 1 and 2, were randomly divided into three groups of 20 patients each. Group I and II patients received i.v. pethidine 0.3 mg/kg and 0.5 mg/kg, respectively, while Group III received i.v. 0.9% normal saline just before induction of general anesthesia. Temperature of the Operating Room and the Post Anesthesia Care Unit was standardized and all fluids given during the study period were warmed to 37°C.Materials and Methods:Temperature, measured with a tympanic membrane probe, was recorded preoperatively, after induction of anesthesia, on arrival at the Post Anesthesia Care Unit, and postoperatively at 15 minutes and 30 minutes. Shivering was graded (0 – 4 scale) at arrival of the patients to the PACU and every five minutes thereafter, up to 30 minutes.Statistical Analysis:ANOVA, Chi-square test, Kruskal-Wallis ANOVA and Mann-Whitney U tests were used. A P-value of less than 0.05 was considered significant.Results:Core body temperatures were statistically insignificant between groups at pre-induction, post-induction, and in the PACU (P > 0.05). At the end of surgery, shivering was present in 18 patients (30%). In groups I, II, and III, six (30%), three (15%), and nine (45%) patients shivered, respectively. The differences in incidence and grading of shivering among groups was found to be statistically insignificant (P > 0.05). The core body temperature of shiverers and non-shiverers were compared. In the PACU at 0, 15, and 30 minutes, the temperature among shiverers was significantly lower than that in the non-shiverers. Rescue drug i.v. pethidine 20 mg was given to patients with shivering grade ≥2. None of the patients had shivering after 10 minutes.Conclusions:Prophylactic pre-induction, low-dose pethidine does not have major role in preventing postoperative shivering.

Comparative efficacy of intravenous dexmedetomidine, clonidine, and tramadol in postanesthesia shivering

“…Bhukal et al . [ 15 ] concluded that prophylactic pre-induction use of low dose pethidine does not have major role in preventing postoperative shivering. Furthermore Zahedi[ 16 ] observed superiority of tramadol to pethidine in preventing shivering, due to its earlier onset of action, less untoward consequences and its higher safety when used as an analgesic in the hands of nonanesthetics.…”

Comparison of the Effects of Intrathecal Meperidine and Morphine on Incidence and Intensity of Shivering After Caesarean Sections Under Spinal Anesthesia: A Randomized Controlled Trial

“…Khan et al (9) found an association between the increased incidence of nausea and vomiting by adding meperidine to subarachnoid administered bupivacaine, and also by higher doses of intrathecal meperidine (25 mg) in comparison to a lesser dose (12.5 mg). Bhukal et al (13) showed that the incidence of shivering was lower in the meperidine 0.5 mg/kg than 0.3 mg/kg but none of these doses of meperidine had a statistically significant adverse effect on patients, compared with placebo. Results of these aforementioned studies are in contrast with our results.…”

“…On the other hand, Khan et al (9) rejected the use of intrathecal meperidine because of increased incidence of nausea and vomiting. This controversy about usefulness and side effects of intrathecal meperidine or morphine is continued in other studies (10)(11)(12)(13), which makes it necessary to conduct further studies.…”

Effect of Preemptive Clonidnine Versus Pethidine and Ketamine on Postoperative Shivering During Spinal Anesthesia

“…In another similar study by Wason et al, prophylactic ketamine had no superior effect to clonidine and tramadol in controlling and decreasing POS (Wason, Jain, Gupta, & Gogia, 2012). Interestingly, unlike clonidine in our study, Bhukal et al showed that low dose pethidine does not decrease incidence of postoperative shivering in laparoscopic surgeries (Bhukal, Solanki, Kumar, & Jain, 2011). Recent publications have mentioned effect of preemptive Dopamine antagonist such as ondancetrone and granicetrone in decreasing post-operative shivering (Sagir et al, 2007;Teymourian et al, 2015).…”