Research Article

A Comparative Study on the Effect of Intravenous Hydrocortisone and Ketamine on Reducing Shivering after Spinal Anesthesia in Cesarean Section: A Double-blind Randomized Controlled Trial


Background: Shivering is rhythmic vibratory motions in one or more group of muscle that caused after general or local anesthesia. Prevention and early treatment of Shivering lead to not conflict with patient monitoring and also reduce cardio-respiratory and metabolic side effects in patients. The aim of this study is comparing effect of ketamine and hydrocortisone on reducing post spinal shivering.
Methods: In this prospective study, 150 pregnant women randomly were divided into three groups after Spinal anesthesia. Patients received 3cc hydrocortisone (2 mg/kg, A group), 3cc ketamine (0.5 mg/kg, B group) and 3cc normal saline (%0.9, C group) intravenously in 10-15 S duration after umbilical cord clamping. In all patients systolic and diastolic pressure, mean arterial pressure, heart rate, oxygen saturation level and body temperature were recorded before anesthesia and then every minute for 5 minutes, every 5 minutes for 15 minutes, every 10 minutes until the end of surgery. Also sedation score, hallucination, nausea and vomiting, intensity of shivering and using amount of pethidine and ephedrine were recorded in questionnaire.
Results: All three groups were similar in basic blood pressure, sensory and motor level. The rate of shivering in hydrocortisone group was significantly lower than control group (P=0.000). The rate of shivering in ketamine group was significantly lower than control group (P=0.00). Also the rate of shivering in hydrocortisone group was significantly higher than ketamine group (P=0.004).
Conclusion: Intravenous Hydrocortisone and ketamine are effective in reducing shivering occurring after spinal anesthesia in the cesarean surgery, however ketamine is significantly more effective than hydrocortisone in shivering control.

Hasannasab B, Banihashem N, Khoshbakht A. Prophylactic Effects of Doxapram, Ketamine and Meperidine in Postoperative Shivering. Anesth Pain Med. 2016; 6(1): e27515.

Bilotta F, Pietropaoli P, Sanitá R, Liberatori G, Rosa G. Nefopam and tramadol for the prevention of shivering during neuraxial anesthesia. Reg Anesth Pain Med. 2002; 27(4):380-4.

Kurz A. Thermal care in the perioperative period. Best Pract Res Clin Anaesthesiol. 2008; 22(1):39-62.

Cunningham F. leveno KJ, Bloom SL, Hauth JC, Rouse DJ, Spong CY. Abortion. Williams Obstetrics. New York: McGraw Hill; 2010, 12:30-57.

Lumbiganon P, Laopaiboon M, Gülmezoglu AM, Souza JP, Taneepanichskul S, Ruyan P, et al. Method of delivery and pregnancy outcomes in Asia: the WHO global survey on maternal and perinatal health 2007–08. Lancet. 2010; 375(9713):490-9.

Nakagawa T, Hashimoto M, Hashimoto Y, Shirozu K, Hoka S. The effects of tramadol on postoperative shivering after sevoflurane and remifentanil anesthesia. BMC Anesthesiol. 2017; 17: 1.

He L, Xu J-M, Liu S-M, Chen Z-J, Li X, Zhu R. Intrathecal Dexmedetomidine Alleviates Shivering during Cesarean Delivery under Spinal Anesthesia. Biol Pharm Bull. 2017; 40(2):169-173.

Zorumski CF, Izumi Y, Mennerick S. Ketamine: NMDA Receptors and Beyond. J Neurosci. 2016; 36(44):11158-64.

Pawar MS, Suri N, Kaul N, Lad S, Khan RM. Hydrocortisone reduces postoperative shivering following day care knee arthroscopy. Can J Anaesth. 2011; 58(10):924-8.

Milnes A, Wilson S. Local anesthetics. Oral Sedation for Dental Procedures in Children: Springer; 2015. p. 57-63.

Sweitzer B. Three Wise Men (× 2) and the ASA-Physical Status Classification System. Anesthesiology. 2017; 126(4):577-578.

Crossley A, Mahajan R. The intensity of postoperative shivering is unrelated to axillary temperature. Anaesthesia. 1994; 49(3):205-7.

Dal D, Kose A, Honca M, Akinci S, Basgul E, Aypar U. Efficacy of prophylactic ketamine in preventing postoperative shivering. Br J Anaesth. 2005; 95(2):189-92.

Roy J-D, Girard M, Drolet P. Intrathecal meperidine decreases shivering during cesarean delivery under spinal anesthesia. Anesth Analg. 2004; 98(1):230-4.

Usta B, Gozdemir M, Demircioglu RI, Muslu B, Sert H, Yaldiz A. Dexmedetomidine for the prevention of shivering during spinal anesthesia. Clinics. 2011; 66(7):1187-91.

Abdelrahman RS. Prevention of shivering during regional anaesthesia: Comparison of Midazolam, Midazolam plus ketamine, Tramadol, and Tramadol plus Ketamine. Life Sci J. 2012; 9(2):132-9.

Elmawgood AA, Rashwan S, Rashwan D. Efficacy of prophylactic use of hydrocortisone and low dose ketamine for prevention of shivering during spinal anesthesia. Egyptian J Anaesth. 2012; 28(3):217-21.

Manouchehrian N, Mohammadian A, Sanie M, Faridi-Tazeh-kand N, Sanatkar M. A comparison of the therapeutic effect of tramadol and meperidine for treatment of shivering after spinal anesthesia in elective caesarean section. Archives of Anesthesiology and Critical Care. 2015; 1(2):50-4.

Modir H, Norouzi A, Pazoki S. Comparing the Efficacy of Different Classes of Drugs for the Prevention of Shivering After General Anesthesia. Arak Medical University Journal (AMUJ). 2013; 16(72): 71-78

IssueVol 4 No 2 (2018): Spring QRcode
SectionResearch Article(s)
Spinal anesthesia cesarean section ketamine Shivering hydrocortisone

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
Manouchehrian N, Sanatkar M, Kimiaei Asadi H, Soleimani E, Moradi A. A Comparative Study on the Effect of Intravenous Hydrocortisone and Ketamine on Reducing Shivering after Spinal Anesthesia in Cesarean Section: A Double-blind Randomized Controlled Trial. Arch Anesth & Crit Care. 4(2):459-63.