Intrathecal fentanyl for prevention of shivering in spinal anesthesia in cesarean section

Shivering is one of the common problems in spinal anesthesia. The objective of the present study was to evaluate the effect of intrathecal fentanyl [25 microg] on incidence and severity of intraoperative and postoperative shivering. A double-blind randomized controlled study was conducted in eighty healthy women [ASA Physical status I] scheduled for elective cesarean section under spinal anesthesia. Subjects were randomly divided into two equal groups. The patients received 12.5 mg [2.5ml] of 0.5% hyperbaric bupivacaine combined with 25 microg [0.5 ml] fentanyl in Group F as a study group and 12.5 mg [2.5ml] of 0.5% hyperbaric bupivacaine combined with 0.5 ml normal saline in Group S as a control group. Incidence of shivering during 30 and 60 minutes of surgery and recovery and complications were evaluated. The total incidence of shivering in Group F was significantly lower than Group S [10% in group F; 75% in group S, p< 0.0001]. Almost all patients started shivering in the first hour after spinal anesthesia and the rate of shivering especially in second 30 minutes was higher than first 30 minutes in both groups. None in Group F but 22 patients [55%] in Group S had shivering during recovery and all of them reported shivering at the first 30 minute at recovery. The severity of shivering in Group F was significantly lower than Group S [p<0.0001]. Intrathecal bupivacaine combined with fentanyl is associated with a lower incidence and severity of shivering

Continous infusion of remifentanil plus ketamine compared with continous remifentanil for pain relief in labor

Pain relief during labour is an important determinant of a women's birth experience. There are numerous pain relief techniques which can be used either with or without pain medication. The aim of our study was to compare the effect of remifentanil alone and its effect in pain relief while using with ketamine during labour. After obtaining informed consent and approval of hospital ethics committee, 40 women with gestational age between 38 and 42 weeks gestation in early labour were recruited for this study. They were randomly allocated into two groups: group RK [20 cases] received 25 micro g remifentanil as a starting dose and continuous infusion of 0.06 micro g/kg/min remifentanil plus 0.5 mg/kg/h ketamine for 4 hours via pump and group R [20 cases] received 25 micro g remifentanil as a starting dose and continous infusion of 0.06 micro g/kg/min remifentanil. The baseline of pain scores were similar in both groups [5.75 +/- 2.51 vs 7 +/- 2.45, p= 0.12] but after 30 minutes to 120 minutes the VAS scores were significantly higher in R group [p< 0.001]. The rate of patients who were satisfied [excellent and very good] in RK was 80% but in R group was 45% [p = 0.03]. Nausea and vomiting were significantly higher in R group [p<0.05]. The remifentanil plus ketamine produced better pain relief during labour with continous monitoring than continous remifentanil with no adverse effects for mothers and infants