The effects of different doses of intrathecal meperidine on the incidence and severity of shivering during lower extremity orthopedic surgery under spinal anesthesia: A randomized, placebo-controlled, double blind-clinical trial

Abstract

Background:Shivering associated with spinal anesthesia is a common complication. It also causes more usage of oxygen, increased production of carbon dioxide (CO2), and lactic acidosis with movement of clots and bleeding after surgery. This study was performed to compare the different dosages of intrathecal meperidine and their effects on shivering during and after surgery and to compare these to the control group.Materials and Methods:This study is a clinical trial. Target population consisted of the patients who were candidates for lower limb orthopedic surgery under spinal anesthesia. About 120 patients were chosen and randomly divided into four groups. In group 1, spinal anesthesia was performed with 3 ml marcaine 0.5% and 0.1 mg/kg meperidine. In group 2, 3 ml marcaine 0.5% and 0.2 mg/kg meperidine was given. In group 3, 3 ml marcaine 0.5% and 0.3 mg/kg meperidine, and in the fourth group, 3 ml marcaine 0.5% and normal saline in the same volume were injected. During surgery and recovery, hemodynamic index and shivering were recorded.Results:Based on the analyzed data, in the fourth group 23 patients (76.7%) had shivering. While the prevalence of shivering in the first, second, and third groups was 15 patients (50%), 11 patients (36.7%), and 3 patients (10%), respectively. Chi-square test showed significant difference in the four groups (P < 0.001).Conclusions:Using higher dosage of intrathecal meperidine (0.3 mg/kg) was more effective than using lower dosage of meperidine (0.1 mg/kg and 0.2 mg/kg) in reducing the incidence and severity of shivering during spinal anesthesia in lower extremity orthopedic surgeries.

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

“…These results are against those of Khan et al, 12 and Anaraki and Mirzaei, 1 but in agreement with the majority of studies that believed that low dose of intrathecal pethidine is effective as a prophylactic drug against shivering without increasing side effects. 10 , 11 , 21 …”

“…These results are in agreement with the results of most studies. 1 , 10 , 18 Although nausea and vomiting are among the complications of i.v. opioids, higher requirement to pethidine in the S group could contribute in increasing nausea and vomiting in this group.…”

“… 6 , 7 It seems that IV pethidine exerts its antishivering effects via the activation of kappa-opioid receptors. 8 – 10 …”

The evaluation of effects two different doses of hydrocortisone on the intensity of perioperative shivering in elective surgery under spinal anesthesia: A double-blind randomized controlled trial study

“…The incidence of this condition varies between 6.3% and 66% depending on the type and duration of operation, anesthesia technique, and patient's age and gender[12345678910] and has minimum incidence to 40% in patients operation with spinal anesthesia. [1011] With regard to the incidence and clinical significance, shivering has been known as the sixth major problem among from 33 clinical cases with the low rate of morbidity in clinical anesthesiology.…”

“…[123456] Some processes can lead to central hypothermia. General and regional anesthesia are the same and in both the distribution of heat is from the center to the initial process environment that in spinal and epidural, the process does not reach to the balance because the environmental vasoconstriction is lost and shivering and low temperature are produced by a small volume of muscles above the block level.…”