Evaluating the Effect of Intrathecal Sufentanil and Meperidine on Shivering after Caesarean Section Under Spinal Anesthesia
AbstractBackground: The present study has evaluated the effect of intrathecal Sufentanil and Meperidine on patients’ shivering after caesarean section.Methods: The present study was a double-blind randomized clinical trial that was conducted on 120 patients. Spinal anesthesia was administered using 2 cc (10 mg) of bupivacaine along with 2.5 µg (0.5 cc) of Sufentanil for the first group, 25 mg (0.5 cc) of Meperidine for the second group and 0.5 cc normal saline for the control group.The severity of patients’ shivering was recorded during the surgery and in the recovery room. Heart rate, respiratory rate, systolic and diastolic blood pressures, oxygen saturation, and core and skin temperatures were measured before anesthesia, 5th minute, 10th minute and then every 15 minutes until the end of the surgery and then every 15 minutes into the recovery until discharge from recovery. The Apgar score of the neonates were also recorded at the 1st and 5th minutes after birth.Results: The mean score of shivering was significantly lower in the Meperidine group (0.1 ± 0.07) than the Sufentanil group (1.2 ± 0.3) and the control group (4.1 ± 0.5) (p< 0.05). The frequency of incidence of shivering was also decreased in Meperidine (5.3%) and Sufentanil (42.1%) groups compared to the control group (p< 0.001). Changes in blood pressure from the 25th minute to the 45th minute of the surgery and during the first 45 minutes into the recovery had more stability in the Meperidine and Sufentanil groups (p< 0.05). Changes in the heart rate respiratory rate, core and skin temperatures and infants’ Apgar score had no statistical difference between the three groups (p > 0.05).Conclusion: Using intrathecal Meperidine and Sufentanil, besides decreasing the incidence of shivering (with more effectiveness from Meperidine), would also increase the block density and quality of relaxation in the patients. It would also lead to improved hemodynamic stability without affecting the sensory block level and infant’s Apgar score.
Cluver C, Novikova N, Hofmeyr GJ, Hall DR. Maternal position during caesarean section for preventing maternal and neonatal complications. The Cochrane Library. 2010.
Gogarten W. Spinal anaesthesia for obstetrics. Best Practice & Research Clinical Anaesthesiology. 2003; 17(3):377-92.
Vercauteren M. Obstetric spinal analgesia and anesthesia. Curr Opin Anaesthesiol. 2003; 16(5):503-7.
Vyas N, Sahu DK, Parampill R. Comparative study of intrathecal sufentanil bupivacaine versus intrathecal bupivacaine in patients undergoing elective cesarean section. J Anaesthesiol Clin Pharmacol. 2010; 26(4):488-92.
Palmer CM, Cork RC, Hays R, Van Maren G, Alves D. The dose-response relation of intrathecal fentanyl for labor analgesia. Anesthesiology. 1998; 88(2):355-61.
Greene NM. Distribution of local anesthetic solutions within the subarachnoid space. Anesth Analg. 1985; 64(7):715-30.
Ngan Kee WD. Intrathecal pethidine: pharmacology and clinical applications. Anaesth Intensive Care. 1998; 26(2):137-46.
Famewo C, Naguib M. Spinal anaesthesia with meperidine as the sole agent. Canadian Anaesthetists’ Society Journal. 1985;32(5):533-7.
Marandola M, Antonucci A, Tellan G, Fegiz A, Fazio R, Scicchitano S, et al. Subarachnoid sufentanil as sole agent vs standard spinal bupivacaine in transurethral resection of the bladder. Minerva Anestesiol. 2005; 71(3):83-91.
Kelsaka E, Baris S, Karakaya D, Sarıhasan B. Comparison of ondansetron and meperidine for prevention of shivering in patients undergoing spinal anesthesia. Reg Anesth Pain Med. 2006; 31(1):40-5.
Albergaria VF, Lorentz MN, Lima FA. Intra-and postoperative tremors: prevention and pharmacological treatment. Rev Bras Anestesiol. 2007; 57(4):431-44.
Ciofolo M, Clergue F, Devilliers C, Ben AM, Viars P. Changes in ventilation, oxygen uptake, and carbon dioxide output during recovery from isoflurane anesthesia. Anesthesiology. 1989; 70(5):737-41.
Eberhart LH, Döderlein F, Eisenhardt G, Kranke P, Sessler DI, Torossian A, et al. Independent risk factors for postoperative shivering. Anesth Analg. 2005; 101(6):1849-57.
Sagir O, Gulhas N, Toprak H, Yucel A, Begec Z, Ersoy O. Control of shivering during regional anaesthesia: prophylactic ketamine and granisetron. Acta Anaesthesiol Scand. 2007; 51(1):44-9.
Dorre N. Miller Anesthesia. Seventh ed. The Postanesthesia Care Unit: Churchil Livingstone Elsevier 2010. 2721 p.
Locks GdF. Incidence of shivering after cesarean section under spinal anesthesia with or without intrathecal sufentanil: A randomized study. Rev Bras Anestesiol. 2012; 62(5):676-84.
Chun D-H, Kil HK, Kim H-J, Park C, Chung K-H. Intrathecal meperidine reduces intraoperative shivering during transurethral prostatectomy in elderly patients. Korean J Anesthesiol. 2010; 59(6):389-93.
de Assunção Braga AdF, Frias JAF, da Silva Braga FS, da Silva Pinto DR. Spinal Block with 10 mg of Hyperbaric Bupivacaine Associated with 5 μg of Sufentanil For Cesarean Section. Study of Different Volumes. Brazilian Journal Anesthesiology. 2010; 60(2):121-9.
Atalay C, Aksoy M, Aksoy A, Dogan N, Kürsad H. Combining intrathecal bupivacaine and meperidine during caesarean section to prevent spinal anaesthesia-induced hypotension and other side-effects. J Int Med Res. 2010; 38(5):1626-36.
Sessler DI. Temperature monitoring and perioperative thermoregulation. Anesthesiology. 2008; 109(2):318-38.
Rathmell JP, Lair TR, Nauman B. The role of intrathecal drugs in the treatment of acute pain. Anesth Analg. 2005; 101(5 Suppl):S30-43.
Rastegarian A, Ghobadifar MA, Kargar H, Mosallanezhad Z. Intrathecal meperidine plus lidocaine for prevention of shivering during cesarean section. Korean J Pain. 2013; 26(4):379-86.
Braga Ade F, Braga FS, Potério GM, Pereira RI, Reis E, Cremonesi E. Sufentanil added to hyperbaric bupivacaine for subarachnoid block in Caesarean section. Eur J Anaesthesiol. 2003; 20(8):631-5.
Safavi M, Honarmand A, Negahban M, Attari M. Prophylactic effects of intrathecal Meperidine and intravenous Ondansetron on shivering in patients undergoing lower extremity orthopedic surgery under spinal anesthesia. J Res Pharm Pract. 2014; 3(3):94-9.
Ozyilkan NB, Kocum A, Sener M, Caliskan E, Tarim E, Ergenoglu P, et al. Comparison of intrathecal levobupivacaine combined with sufentanil, fentanyl, or placebo for elective caesarean section: a prospective, randomized, double-blind, controlled study. Curr Ther Res Clin Exp. 2013; 75: 64–70.
Hein A, Gillis-Haegerstrand C, Jakobsson JG. Neuraxial opioids as analgesia in labour, caesarean section and hysterectomy: A questionnaire survey in Sweden. Version 2. F1000Res. 2017; 6:133.
Abdollahpour A, Azadi R, Bandari R, Mirmohammadkhani M. Effects of adding midazolam and sufentanil to intrathecal bupivacaine on analgesia quality and postoperative complications in elective cesarean section. Anesth Pain Med. 2015; 5(4): e23565.
Hu J, Zhang C, Yan J, Wang R, Wang Y, Xu M. Sufentanil and Bupivacaine Combination versus Bupivacaine Alone for Spinal Anesthesia during Cesarean Delivery: A Meta-Analysis of Randomized Trials. PloS one. 2016; 11(3):e0152605.