Prophylactic Intrathecal Versus Intravenous Meperidine for Shivering After Spinal Anesthesia in Elective Cesarean Section: A Three-Arm, Randomized, Double-Blind, Placebo-Controlled Trial; [مقایسه ی تجویز پیشگیرانه مپریدین داخل نخاعی در مقابل داخل وریدی برای لرز پس از بی حسی اسپاینال در سزارین الکتیو کار آزمایی بالینی سه گروهی تصادفی دوسوکور و کنترل شده با دارونما] Publisher

Summary: Can low-dose spinal meperidine prevent shivering during cesarean surgery? A randomized trial reports less shivering than placebo, with similar efficacy to IV dosing. #Anesthesia #MaternalHealth

Masaeli M ; Mahdavifar F ; Sindarreh S ; Raaya B N
Source: Journal of Isfahan Medical School Published:2026

Abstract

Background: Shivering is one of the common side effects of spinal anesthesia in cesarean section. This study aimed to compare the preventive effect of intrathecal (IT) and intravenous (IV) meperidine on shivering after spinal anesthesia in elective cesarean section. Methods: In this randomized, double-blind, placebo-controlled trial, 151 parturients (ASA physical status II, aged 18–47) scheduled for elective cesarean section under spinal anesthesia were allocated into three groups: the Intrathecal Meperidine group (MEP-IT, n = 49; receiving 15.12-15 hyperbaric bupivacaine plus 0.1mg/kg intrathecal meperidine, and 1m IV normal saline), the Intravenous Meperidine group (MEP-IV, n = 51; receiving bupivacaine intrathecally plus 0.3 mg/kg IV meperidine), and the Control group (n = 51; receiving bupivacaine intrathecally plus IV normal saline)/ Shivering incidence, severity (graded 0–4), hemodynamic parameters, and core temperature were monitored for 60 minutes. Findings: The overall incidence of shivering differed significantly among the groups (P = 0.034), with the lowest rate observed in the MEP-IT group (24.5 %) compared to the MEP-IV (33.3 %) and Control groups (49.0%). Pairwise comparisons revealed a significant reduction in shivering incidence only between MEP-IT and Control (P = 0.013), whereas differences between MEP-IT and MEP-IV (P = 0.226) and between MEP-IV and Control (P = 0.159) were not statistically significant. At 1-minute post-intervention, mean arterial pressure (MAP) was significantly lower in the MEP-IV group compared to the other groups (P < 0.0001) / Core temperature showed significant intergroup differences before (P < 0.0001) and during shivering (P < 0.0001). Conclusion: Prophylaxis with low-dose intrathecal meperidine (0.1mg/kg) is effective in reducing the incidence of post-spinal shivering compared to placebo, showing comparable efficacy to intravenous meperidine (0.3mg/kg) but with a more stable early hemodynamic profile. © 2026, Isfahan University of Medical Sciences(IUMS). All rights reserved.