Department of Anesthesiology, Tehran University of Medical Science, Imam Khomeini Medical Center, Keshavarz Blvd., Tehran 1419733141, Iran.
Eur J Anaesthesiol. 2011 Mar;28(3):202-6. doi: 10.1097/EJA.0b013e3283430802.
Shivering causes various adverse disturbances and interferes with monitoring. The optimal dose of intrathecal meperidine to prevent shivering without producing other side-effects remains unknown. This prospective randomised double-blinded study was conducted to compare the antishivering effects of two different doses of intrathecal meperidine.
Seventy two parturients, scheduled for elective caesarean section under spinal anaesthesia, were enrolled in three different groups. Spinal anaesthesia consisted of bupivacaine 0.5% (10 mg) for the control group (M0), and the same dose of bupivacaine with meperidine 12.5 or 25 mg for the experimental groups (M1, M2). Blood pressure, heart rate, skin and core temperatures, sensory level, capnometry, pulse oximetry, Apgar scores, shivering intensity and intrathecal opioid-related side-effects were evaluated and recorded by a blinded observer. Data were analysed using analysis of variance, χ² test, Kruskal-Wallis H-test and Mann-Whitney U-test. A P value less than 0.05 was considered to be significant.
Shivering was more intense in group M0 than in groups M1 and M2 with P values of 0.003 and less than 0.001, respectively. The intensity of shivering was comparable in groups M1 and M2. As regards the incidence of significant shivering, it was found to be highest in M0 (4/24 ≈16.7%) in comparison with M1 (0/24) and M2 (0/24) (P = 0.03). Nausea and vomiting occurred more frequently with higher doses of meperidine (P < 0.001 and P = 0.003, respectively). Other complications were comparable.
The use of intrathecal meperidine for caesarean section during spinal anaesthesia for the prevention of shivering cannot be recommended as its use is associated with increased incidence of nausea and vomiting.
颤抖会引起各种不良干扰，并妨碍监测。鞘内给予哌替啶以预防颤抖而不产生其他副作用的最佳剂量仍不清楚。本前瞻性随机双盲研究旨在比较鞘内给予两种不同剂量哌替啶的抗颤抖效果。
72 例择期行脊髓麻醉下剖宫产术的产妇被纳入三个不同的组。脊髓麻醉由布比卡因 0.5%（10mg）组成，对照组（M0），实验组（M1、M2）使用相同剂量的布比卡因加哌替啶 12.5 或 25mg。由盲法观察者评估和记录血压、心率、皮肤和核心温度、感觉水平、呼气末二氧化碳分压、脉搏血氧饱和度、阿普加评分、颤抖强度和鞘内阿片类药物相关副作用。数据采用方差分析、卡方检验、Kruskal-Wallis H 检验和 Mann-Whitney U 检验进行分析。P 值小于 0.05 被认为具有统计学意义。
M0 组的颤抖强度明显高于 M1 和 M2 组，P 值分别为 0.003 和小于 0.001。M1 和 M2 组的颤抖强度相当。至于明显颤抖的发生率，M0 组最高（4/24≈16.7%），与 M1 组（0/24）和 M2 组（0/24）相比（P=0.03）。哌替啶剂量较高时，恶心和呕吐更为频繁（P<0.001 和 P=0.003）。其他并发症相当。
鞘内给予哌替啶预防脊髓麻醉下剖宫产术中的颤抖不能被推荐，因为它与恶心和呕吐发生率增加有关。
