Canadian Journal of Anaesthesia

, Volume 35, Issue 2, pp 128–133

Intravenous meperidine for control of shivering during Caesarean section under epidural anaesthesia

  • William F. Casey
  • Charles E. Smith
  • Joel M. Katz
  • Kathleen O’Loughlin
  • Sally K. Weeks
Article

Abstract

To determine the efficacy of meperidine in controlling shivering during epidural anaesthesia for Caesarean section, forty-six parturients were studied. After delivery of the infant, shivering patients received either a single dose of intravenous meperidine 50 mg, or saline in a randomized double-blind fashion. Shivering was classified on a scale of 0 to 3 (grade 0 = none, grade 3 = severe shivering that was distressing to the patient and interfered with monitoring). Shivering and other variables were recorded at epidural placement, skin incision, delivery, and 2,5,15,30 and 60 minutes following injection. Administration of meperidine resulted in a significant decrease in both the overall incidence of shivering (87 to 35 per cent, p < 0.0 J) and severity of shivering (grade 3: 57 to 0 per cent, p < 0.01), compared with saline (incidence: 87 to 83 per cent, grade 3:57 per cent, no change). This effect was apparent within two minutes of drug injection and persisted throughout the study period. There were no differences in vital signs, oxygen saturation or temperature between groups. The incidence of nausea was similar, although patients receiving meperidine were more drowsy at two and five minutes following injection (p < 0.01) compared with patients in the saline group. There were no differences in level of consciousness at the later intervals. The mechanism of action of meperidine on shivering remains to be elucidated.

Key words

anaesthesia: obstetrics anaesthesia techniques:epidural complications: shivering analgesics narcotic: intravenous meperidine 

Résumé

Afin de déterminer ľefficacité de la mépéridine dans le contrôle des frissons lors ďune anesthésia épidurale pour césarienne, 46 parturientes ont été étudiées. Après ľccouchement de ľenfant, les patientes avant frissonné ont reçu à double insu soit une dose unique intraveineuse de mépéridine 50 mg ou du salin après randomisation. Les frissons ont été classifiés selon une échelle de 0 à 3 (grade 0 = aucun, grade 3 = frisson sévère qui était inconfortable pour la patiente et interférant avec la surveillance). Les frissons ainsi que ďautres variables ont été enregistrés lors de la mise en place de ľépidurale, ľincision, ľaccouchement, età 2, 5, 15, 30 et 60 minutes après ľinjection, ľadministration de mépéridine provoqua une diminution significative de ľincidence totale des frissons (87 à 35 pour cent, p < 0.01) ainsi que de la sévérité des frissons (grade 3: 57 à Opourcent,p <0.01), comparativement au salin (incidence: 87 â 83 pour cent, grade 3:57 pour cent, aucun changement). Cet effet était apparent en dedans de deux minutes après ľinjection du médicament et persista tout le long de ľétude. II n’y avait aucune différence dans les signes vitaux, la saturation ďoxygène ou la température entre les groupes. Ľincidence des nausées était identique même si les patientes avant reçu la mépéridine étaient plus somnolentes à 2 et 5 minutes après ľinjection (p < 0.01) comparativement au groupe salin. II n’y avait aucune différence dans le niveau de conscience aux autres phases de ľétude. Le mécanisme ďaction de la mépéridine sur les frissons demeure à être élucidé.

References

  1. 1.
    Ostheimer GW, Datta S. Observations in the postpartum recovery room after various local anaesthetic techniques. Regional Anesthesia 1981; 6: 13–7.Google Scholar
  2. 2.
    Jaameri KEU, Jahkola A, Perttu J. On shivering in association with normal delivery. Acta Obstei Gynecol Scand 1966; 45: 383–8.CrossRefGoogle Scholar
  3. 3.
    Webb PJ, James FM, Wheeler AS. Shivering during epidural analgesia in women in tabor. Anesthesiology 1981; 55: 706–7.PubMedCrossRefGoogle Scholar
  4. 4.
    Bay J, Nunn JF, Prys Roberts C. Factors influencing arterial P02 during recovery from anaesthesia. Br J Anaesth 1968; 40: 398–407.PubMedCrossRefGoogle Scholar
  5. 5.
    Prys Roberts C. Post-anesthesia shivering. In: Artusio JF, ed. Clinical anesthesia. Philadelphia: FA Davis, 1968: 358.Google Scholar
  6. 6.
    Holdcroft A, Hall GM. Heat loss during anaesthesia. Br J Anaesth 1978; 50: 157–64.PubMedCrossRefGoogle Scholar
  7. 7.
    Pauca AL, Savage RT, Simpson S, Roy RC. Effect of pethidine, fentanyl and morphine on post-operative shivering in man. Acta Anaesthesiol Scand 1984, 28: 138–43.PubMedCrossRefGoogle Scholar
  8. 8.
    Burks C, Aisner J, Foster CL.et al. Meperidine for the treatment of shaking chills and fever. Arch Intern Med 1980; 140: 483–4.PubMedCrossRefGoogle Scholar
  9. 9.
    Guffin A, Girard D, Kaplan JA. Shivering following cardiac surgery: haemodynamic changes and reversal. J Cardiothor Anesth 1987; 1; 24–8.CrossRefGoogle Scholar
  10. 10.
    Dixon WJ, Massey FJ, Introduction to Statistical Analysis. 3rd edition, McGraw Hill Book Co., New York 1969.Google Scholar
  11. 11.
    Swinstow TDV. Statistics at Square One. British Medical Association, London 1977.Google Scholar
  12. 12.
    Siegel S. Nonparametric Statistics for the Behavioural Sciences. McGraw Hill Book Co., New York 1956.Google Scholar
  13. 13.
    Downing JW. Bupivacaine: a clinical assessment in lumbar extradural block. Br J Anaesth 1969; 41: 427–32.PubMedCrossRefGoogle Scholar
  14. 14.
    Waters HR, Rosen N, Perkins DH. Extradural blockade with bupivacaine. Anaesthesia 1970; 25: 184–90.PubMedCrossRefGoogle Scholar
  15. 15.
    Roe CF, Goldberg MJ, Blair CS, Kinney JM. The influence of body temperature on early postoperative oxygen consumption. Surgery 1966; 60: 85–92.Google Scholar
  16. 16.
    Jones HD, McLaren CAB. Postoperative shivering and hypoxaemia after halothane, nitrous oxide and oxygen anaesthesia. Br J Anaesth 1965; 37: 35–41.PubMedCrossRefGoogle Scholar
  17. 17.
    Horvath SM, Spurr GB, Hutt BK, Hamilton LH. The metabolic cost of shivering. J Appl Physiol 1956; 8: 595–602.PubMedGoogle Scholar
  18. 18.
    Chamberlain DP, Chamberlain DDL. Changes in the skin temperature of the trunk and their relationship to sympathetic blockade during spinal anesthesia. Anesthesiology 1986; 65: 139–43.PubMedCrossRefGoogle Scholar
  19. 19.
    Pflug AE, Aasheim GM, Foster C, Martin RW. Prevention of postanaesthesia shivering. Can Anaesth Soc J 1978; 25: 43–9.PubMedCrossRefGoogle Scholar
  20. 20.
    Walmsley AJ, Giesecke AH, Lipton JM, Epidural temperature: a cause of shivering during epidural anesthesia. Anesth Analg 1986; 65: S164.Google Scholar
  21. 21.
    Workhoven NM. Intravenous fluid temperature, shivering and the parturient. Anesth Analg 1986; 65; 496–8.PubMedCrossRefGoogle Scholar
  22. 22.
    Fruhslorfer H, Zenz M, Nolte H et al. Dissociated loss of cold and warm sensibility during regional anaesthesia. Pfluegers Arch 1974; 349: 73–82.CrossRefGoogle Scholar
  23. 23.
    Thauer R, Simon E. Spinal cord and temperature regulation. Advances in Climatic Physiology. Ito S, Ogata K, Yoshimura H (Eds). Tokyo, Izaku Shoin Ltd., 1972; pp. 22–49.Google Scholar
  24. 24.
    Bromage PR. Epidural Analgesia. Philadelphia: WB Saunders Co., 1978; pp. 394–6.Google Scholar
  25. 25.
    McCarroll SM, Cartwright P, Weeks SK, Donati F. Warming intravenous fluids and the incidence of shivering during Caesarean section under epidural anaesthesia. Can J Anaesth 1986; 33: S72-S73.Google Scholar
  26. 26.
    Holdcroft A, HallG M, Cooper GM. Redistribution of body heat during anaesthesia. Anaesthesia 1979; 34: 758–64.PubMedCrossRefGoogle Scholar
  27. 27.
    Claybon LE, Hirsh RA. Meperidine arrests post-anesthesia shivering. Anesthesiology 1980; 53: S180.CrossRefGoogle Scholar
  28. 28.
    Harris MM, Arnold WP, Lawson D, Ellis JE. Meperidine does not prevent shivering following epidural lidocaine. Regional Anesthesia 1987; 12: 57–8.Google Scholar
  29. 29.
    Harris WS, Lipton JM. Intracerebroventricular taurine in rabbits: effects on normal body temperature, endotoxin fever and hyperthermia produced by PGE and amphetamine. J Physiol (Lond) 1977; 266: 397–410.PubMedGoogle Scholar
  30. 30.
    Clark SM, Upton JM. Hypothermia produced in aged squirrel monkeys by central administration of taurine. Exp Aging Res 1981; 7: 17–24.PubMedGoogle Scholar
  31. 31.
    Murphy MT, Lipton JM, Louglran P, Giesecke Jr AH. Postanesthetic shivering in primates: inhibition by peripheral heating and by taurine. Anesthesiology 1985; 63: 161–5.PubMedCrossRefGoogle Scholar
  32. 32.
    Yaksh TL. Multiple opioid receptor systems in brain and spinal cord. Pan I. Eur J Anaesthesiol 1984; 1: 171–99.Google Scholar
  33. 33.
    Sharkey A, Lipton JM, Murphy MT.Giesecke AH. Inhibition of postanesthetic shivering with radiant heat. Anesthesiology 1987; 66: 249–52.PubMedCrossRefGoogle Scholar

Copyright information

© Canadian Anesthesiologists 1988

Authors and Affiliations

  • William F. Casey
    • 1
  • Charles E. Smith
    • 1
    • 2
  • Joel M. Katz
    • 1
  • Kathleen O’Loughlin
    • 1
  • Sally K. Weeks
    • 1
  1. 1.Department of AnaesthesiaRoyal Victoria Hospital and McGill UniversityMontrcal
  2. 2.Department of Cardiothoracic AnesthesiaCleveland ClinicClevelandOhio

Personalised recommendations