effects of warm and cold intrathecal bupivacaine on shivering during delivery under spinal anesthesia

Shivering associated with neuraxial anesthesia is a common problem that is uncomfortable for patients; it is of unknown ethnology and has no definite treatment. The purpose of this study was to compare the effects of warm intrathecal bupivacaine stored at 23°C and cold intrathecal bupivacaine stored at 4°C on shivering during delivery under spinal anesthesia. Seventy-eight parturient women scheduled for nonemergency cesarean delivery were enrolled in the study and separated into 2 groups. The standard group received 10 mg of heavy bupivacaine 0.5% stored at room temperature [23°C] plus 10 microg of fentanyl intrathecally [warm group], and the case group received 10 mg of heavy bupivacaine 0.5% stored at 4 C plus 10 microg of fentanyl intrathecally [cold group]. Data collection, including sensory block level, blood pressure, core temperature, and shivering intensity, was first performed every minute for 10 min, then every 5 min for 35 min and, finally, every 10 min until the sensory level receded to L4. There were no differences between the 2 groups in the amount of bleeding, pulse rate, oxygen saturation, neonatal Apgar, and incidence of vomiting. The incidence and intensity of shivering decreased in the warm group [P=0.002]. Warming of solutions can reduce the incidence and intensity of shivering in parturient candidates for cesarean delivery under spinal anesthesia

effect of different intrathecal doses of meperidine on shivering during delivery under spinal anesthesia

This study was performed to compare the effect of different doses of intrathecal meperidine on the incidence and intensity of shivering and other side-effects after spinal anesthesia for cesarean delivery. One hundred and fifty-six parturient women scheduled for elective cesarean delivery were enrolled in four groups. Spinal anesthesia consisted of heavy bupivacaine 0.5% [10 mg] in the standard group [Group I], heavy bupivacaine 0.5% [10 mg] plus meperidine [0.2 mg per kg] in Group II, heavy bupivacaine 0.5% [10 mg] plus meperidine [0.3 mg per kg] in Group III, heavy bupivacaine 0.5% [10 mg] plus meperidine [0.4 mg per kg] in Group IV. The signs and symptoms were recorded by an observer unaware of the study groups. The systolic blood pressure, amount of bleeding, Pulse Rate, O2 saturation, neonatal apgar scores, core temperatures and sensory level revealed no difference between groups [P > 0.05]. The incidence [47.5%, 37.5%, 27.5% and 15.0%, respectively] and intensity of shivering decreased as the dose of meperidine increased [P=0.002] but the incidence of nausea and vomiting [8.0%, 15.4%, 25.9% and 35.8%, respectively] [P=0.000] and pruritis [25.64, 28.21, 38.46, and 48.72 respectively] increased as the dose of meperidine increased [P=0.000]. The high dose of intrathecal meperidine is effective in reducing the incidence and intensity of shivering associated with spinal anesthesia for cesarean delivery but the high incidence of nausea and vomiting is unpleasant for the patient and can be a major problem with a high dose of meperdine