Jayaraj Ashokkumar, Balachander Hemavathi, Kuppusamy Suresh K, Arusamy Sivakumar, Rai Yeshith, Siddiqui Naveed
Department of Anesthesia and Pain Management, Mount Sinai Hospital, Toronto, Ontario, Canada.
University of Toronto, Toronto, Ontario, Canada.
J Obstet Gynaecol Res. 2019 Nov;45(11):2202-2208. doi: 10.1111/jog.14106. Epub 2019 Sep 4.
To assess the effects of intravenously administered meperidine, fentanyl and tramadol in reducing the incidence, onset time and severity of the shivering response in parturients during cesarean delivery under spinal anesthesia. Secondary outcomes included patient satisfaction and sedation scores.
After Ethics board approval and informed written consent, 350 parturients (ASA physical status I or II), between 20 and 40 years of age, undergoing emergency or elective cesarean delivery under spinal anesthesia were recruited. Parturients were then randomly allocated to seven study groups: normal saline (control), low-dose meperidine (0.5 mg/kg), high-dose meperidine (0.75 mg/kg), low-dose fentanyl (0.5 mcg/kg), high-dose fentanyl (0.75 mcg/kg), low-dose tramadol (0.5 mg/kg) and high-dose tramadol (0.75 mg/kg). The incidence, onset time and severity of shivering, along with patient satisfaction and sedation scores were measured.
All study drugs showed significant reduction in incidence, onset time and severity of shivering and greater satisfaction scores compared to the control group (P < 0.01). Within each drug class, no significant differences in shivering were found between the high-dose and low-dose groups. Among study drugs, low-dose tramadol was superior due to shivering prevention and significantly reduced sedation.
Intravenously administered meperidine, fentanyl and tramadol reduce shivering incidence, onset time and severity in parturients undergoing cesarean delivery following spinal anesthesia. Importantly, low-dose intravenous tramadol (0.5 mg/kg) allowed shivering prevention and low sedation scores, thereby offering greater parturient satisfaction and better maternal-newborn bonding.
评估静脉注射哌替啶、芬太尼和曲马多对降低脊麻下剖宫产产妇寒战反应的发生率、发作时间和严重程度的影响。次要结局包括患者满意度和镇静评分。
经伦理委员会批准并获得书面知情同意后，招募350例年龄在20至40岁之间、美国麻醉医师协会（ASA）身体状况为I或II级、接受脊麻下急诊或择期剖宫产的产妇。然后将产妇随机分为七个研究组：生理盐水（对照组）、低剂量哌替啶（0.5mg/kg）、高剂量哌替啶（0.75mg/kg）、低剂量芬太尼（0.5μg/kg）、高剂量芬太尼（0.75μg/kg）、低剂量曲马多（0.5mg/kg）和高剂量曲马多（0.75mg/kg）。测量寒战的发生率、发作时间和严重程度，以及患者满意度和镇静评分。
与对照组相比，所有研究药物均显示寒战的发生率、发作时间和严重程度显著降低，满意度评分更高（P<0.0）。在每个药物类别中，高剂量组和低剂量组之间的寒战无显著差异。在研究药物中，低剂量曲马多在预防寒战方面更具优势，且镇静作用显著降低。
静脉注射哌替啶、芬太尼和曲马多可降低脊麻下剖宫产产妇的寒战发生率、发作时间和严重程度。重要的是，低剂量静脉注射曲马多（0.5mg/kg）可预防寒战且镇静评分低，从而提高产妇满意度并改善母婴关系。
