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Anti-shivering effects of intrathecal fentanyl versus meperidine in cesarean delivery: a prospective observational pilot study
Abstract Number: T3B-6
Abstract Type: Original Research
Shivering in parturients undergoing cesarean delivery (CD) with spinal anesthesia occurs with an average incidence of 52% in meta-analysis studies. Not only is it often cited as a source of discomfort and dissatisfaction in parturients undergoing CD, shivering increases oxygen consumption and carbon dioxide production, increasing the risk of complications in patients who have cardiac or pulmonary comorbidities. The addition of various pharmacological agents to neuraxial anesthesia can decrease the incidence of shivering, though it remains unclear which agent most effectively reduces shivering while maintaining the lowest incidence of side effects. We conducted a prospective observational study to compare the relative anti-shivering effect of fentanyl versus meperidine during spinal anesthesia.
Twenty-six parturients scheduled for elective cesarean section under spinal anesthesia were observed for this preliminary study. Spinal anesthesia consisted of 0.75% hyperbaric bupivacaine (1.4-1.8 cc) combined with 0.1 mg of intrathecal morphine. Twelve patients received intrathecal fentanyl (Group F) while 14 patients received intrathecal meperidine (Group M). Vitals and core temperature (Braum ThermoScan® 5) were assessed at the following time intervals: every 15 minutes for first 75 minutes after spinal placement; at time of PACU admission; every hour thereafter for 4 hours. Shivering intensity was graded from 0-4 based on the Crossley and Mahajan scale. Data were analyzed using analysis of variance, Kruskal–Wallis H-test and Mann-Whitney U-test, and chi-squared test as appropriate.
Total shivering incidence was 38.5%. Incidence and intensity of shivering did not differ between Group F and Group M. While baseline temperatures were comparable, Group F demonstrated a greater decrease from baseline (mean ΔT of 1.57 °C) as compared to Group M (mean ΔT 1.28 °C, p = 0.031). Mean core temperature for Group F was statistically lower at several time points: 60 and 75 min after spinal placement, upon PACU admission, and 120 min thereafter (see Table 1). There was no difference in side effect profiles.
The anti-shivering effects of intrathecal meperidine and fentanyl are comparable. Patients receiving intrathecal fentanyl demonstrate a greater drop from core temperature and lower mean core temperatures at several time points after spinal placement.