title: Effects of Adding Midazolam and Sufentanil to Intrathecal Bupivacaine on Analgesia Quality and Postoperative Complications in Elective Cesarean Section Intrathecal Meperidine Plus Lidocaine for Prevention of Shivering during Cesarean Section Intrathecal Dexmedetomidine Alleviates Shivering during Cesarean Delivery under Spinal Anesthesia. The Effects of Preemptive Tramadol and Dexmedetomidine on Shivering During Arthroscopy Analgesic effects of intrathecal tramadol in patients undergoing caesarean section: a randomised, double-blind study. Comparison of the effects of intrathecal morphine and pethidine on shivering after Caesarean delivery under combined‐spinal epidural anaesthesia * Incidence of shivering after cesarean section under spinal anesthesia with or without intrathecal sufentanil: a randomized study. Subarachnoid Fentanyl Augments Lidocaine Spinal Anesthesia for Cesarean Delivery Intrathecal fentanyl for prevention of shivering in spinal anesthesia in cesarean section Intrathecal sufentanil decreases the median effective dose (ED50) of intrathecal hyperbaric ropivacaine for caesarean delivery Effect of low dose of intrathecal pethidine on the incidence and intensity of shivering during cesarean section under spinal anesthesia: a randomized, placebo-controlled, double-blind clinical trial Effects of intrathecal dexmedetomidine on shivering after spinal anesthesia for cesarean section: a double-blind randomized clinical trial Intrathecal injection of magnesium sulfate: shivering prevention during cesarean section: a randomized, double-blinded, controlled study Intraoperative conditions and quality of postoperative analgesia after adding dexmedetomidine to epidural bupivacaine and fentanyl in elective cesarean section using combined spinal-epidural anesthesia Intrathecal fentanyl for prevention of shivering in cesarean section. Epidural ropivacaine 1% with and without sufentanil addition for Caesarean section Comparison of Intrathecal Dexmedetomidine with Morphine as Adjuvants in Cesarean Sections. Shivering following cardiac surgery: hemodynamic changes and reversal. The effect of adding magnesium sulphate to epidural bupivacaine and fentanyl in elective caesarean section using combined spinal-epidural anaesthesia: a prospective double blind randomised study. Prevention of hypotension and prolongation of postoperative analgesia in emergency cesarean sections: A randomized study with intrathecal clonidine Efficacy of lipophilic vs lipophobic opioids in addition to hyperbaric bupivacaine for patients undergoing lower segment caeserean section Antishivering effects of two different doses of intrathecal meperidine in caesarean section: a prospective randomised blinded study Effect of adrenaline, fentanyl and warming of injectate on shivering following extradural analgesia in labour. [Application of dexmedetomidine combined with ropivacaine in the cesarean section under epidural anesthesia]. Low-dose ropivacaine-sufentanil spinal anaesthesia for caesarean delivery: a randomised trial. [Preventive therapy for nausea and vomiting in patients on opioid therapy for non-malignant pain in rheumatology]. Intrathecal Meperidine Decreases Shivering During Cesarean Delivery Under Spinal Anesthesia
abstract: Background : Intrathecal adjutants can be used for regional anesthesia ( RA ) in cesarean section to improve its quality in terms of time and complications . Some previous studies focused on the effects of adding sufentanil and /or midazolam to bupivacaine and compared each with using bupivacaine alone . However , there has been no study to assess the effects of using sufentanil and midazolam in combination with bupivacaine . Objectives : The aim of this study was to evaluate and compare properties ( time of achievement/recovery of sensory/motor blocks ; and time to request opium ) , complications ( nausea , vomiting , shivering and hypotension ) , and neonatal first minute Apgar score with and without the addition of midazolam ( M ) or sufentanil ( S ) to bupivacaine ( B ) through intrathecal injection for spinal anesthesia , after the cesarean section . Patients and Methods : In this double blind r and omized clinical trial participants were r and omly allocated to three equal groups : Group B ( 2.5 cc of bupivacaine 0.5 % + 1 cc normal saline 0.9 % ) , Group BM ( 2.5 cc of bupivacaine + 0.02 mg/kg midazolam ) and Group BS ( 2.5 cc of bupivacaine 0.5 % + 0.7 cc normal saline 0.9 % + 1.5 µg of sufentanil , 0.3 cc ) . We used analysis of variance ( ANOVA ) , post hoc test with Bonferroni adjustment , and chi-square test for statistical analysis ; the analyses were performed using the SPSS-16 software . Given a significant level of 0.05 , overall and pair-wise comparisons were made . Results : Seventy-five females participated in the study with no significant age difference ( mean ± st and ard deviation ( SD ) : 28.60 ± 6.06 , 28.12 ± 5.29 and 28.76 ± 3.97 year ; P = 0.9 ) . Except for “ time to motor block recovery ” ( P = 0.057 ) , the overall differences among the three groups was significant in terms of “ time to sensory/motor block ” ( P < 0.001 ) , “ time to sensory block recovery ” ( P < 0.001 ) , and “ time to request opium ” ( P < 0.001 ) . In all pair-wise comparisons there was no significant difference between the BM and BS group , except for “ time to request opium ” , which was longer in the BS group ( P < 0.001 ) . The occurrence of nausea ( P = 0.02 ) , postoperative shivering ( P = 0.01 ) and hypotension ( P < 0.001 ) were significantly different between the groups , unlike vomiting , where the difference was not significant ( P = 0.2 ) . All neonates had an Apgar score of nine . Conclusions : The findings showed that adding sufentanil or midazolam to bupivacaine shortens the onset of spinal anesthesia and increases the time duration of anesthesia ; however it does not change the motor block recovery time . Adding sufentanil delays the first request for narcotic analgesics while adding midazolam leads to a decrease in nausea and hypotension . Adding sufentanil or midazolam does not have any deleterious effect on infants ’ Apgar scores . However , increases shivering in patients Background Shivering related to spinal anesthesia may interfere with monitoring and is uncomfortable . The aim of the present study was to investigate low-dose intrathecal meperidine for the prevention of shivering after induction of spinal anesthesia in parturients with cesarean section . Methods This was a prospect i ve r and omized , double-blind , placebo-controlled trial including 100 parturients , of American Society of Anesthesiologists ( ASA ) physical status I or II , scheduled for elective cesarean section under spinal anesthesia who were r and omly assigned to a meperidine ( 0.2 mg/kg ) plus hyperbaric lidocaine ( 5 % , 75 mg , n = 50 ; group M ) group or a placebo plus hyperbaric lidocaine ( 5 % , 75 mg , n = 50 ; group L ) group . Demographic and surgical data , adverse events , and the mean intensity for each parturient were assessed during the entire study period by a blinded observer . Results There were no significant differences between the two study groups regarding the demographic and surgical data ( P > 0.05 ) . The incidence of shivering during the entire study period significantly decreased in the group of parturients who received intrathecal meperidine ( P = 0.04 ) . There were no significant differences in nausea and vomiting between the two groups . Conclusions Low-dose intrathecal meperidine ( 10 mg ) is safe and effective in reducing the incidence and severity of shivering associated with spinal anesthesia in parturients with cesarean section Shivering associated with spinal anesthesia during Cesarean delivery is an uncomfortable experience for the parturient , which may also cause adverse effects . In this prospect i ve , r and omized , double-blind , placebo-controlled study , we sought to evaluate the effect of intrathecal dexmedetomidine , administered as an adjunct to hyperbaric bupivacaine for Cesarean delivery , on the incidence and severity of shivering associated with spinal anesthesia . Patients undergoing Cesarean delivery were r and omly allocated to three groups of 30 patients each . Experimental treatments were added to hyperbaric bupivacaine as follows : Patients in group I ( control ) were administered isotonic saline . Patients in groups II and III received dexmedetomidine ( 2.5 , 5 µg , respectively ) , mixed with isotonic saline . Shivering was observed in 11 , 10 and 2 patients in groups I , II and III , respectively . The incidence of shivering in group III was significantly lower than that in groups I ( p=0.005 ) and II ( p=0.01 ) . The severity of shivering was significantly different between the three groups ( p=0.01 ) . There were no significant inter-group differences with respect to mean arterial pressure and heart rate at any time point after administration of intrathecal local anesthesia ( p>0.05 ) . Intrathecal dexmedetomidine ( 5 µg ) administered as an adjunct to hyperbaric bupivacaine during Cesarean delivery significantly reduced the incidence and intensity of shivering associated with spinal anesthesia Background : Shivering , the rate of which in regional anesthesia is 39 % is an undesired complication seen postoperatively . Aims : This study aims to compare the ability of preventing the shivering of preemptive tramadol and dexmedetomidine during the spinal anesthesia ( SA ) . Methods : A total of 90 patients with American Society of Anesthesiologists physical status I-II , aged 18 - 60 years and undergoing elective arthroscopic surgery with SA were divided into three groups r and omly . After spinal block , 100 mg tramadol in 100 ml saline was applied in group T- ( n = 30 ) and 0.5 μg/kg dexmedetomidine in 100 ml saline was applied in group D- ( n = 30 ) and 100 ml saline was administered in group P- ( n = 30 ) in 10 min . The hemodynamics , oxygen saturation , tympanic temperature , shivering and sedation scores were evaluated and recorded intraoperatively and 45 min after a postoperative period . Results : In group T and D , shivering scores were significantly lower when compared with group P in the intraoperative 20th min ( P = 0.01 ) . Sedation scores in group D were significantly higher than the baseline values ( P = 0.03 ) and values in group T and P ( P = 0.04 ) . Conclusions : Preemptive tramadol and dexmedetomidine are effective in preventing the shivering under SA . In addition , dexmedetomidine was superior in increasing the level of sedation which is sufficient to prevent the anxiety without any adverse effects BACKGROUND Intrathecal tramadol combined with local anaesthetics has been used for postoperative analgesia following lower abdominal and perineal surgery . The present study evaluated the effect of intrathecal tramadol on spinal block characteristics and neonatal outcome after elective caesarean section . METHODS Eighty full-term parturients scheduled for elective caesarean section were r and omly divided into two groups . In the fentanyl group , patients received intrathecal 0.5 % bupivacaine 10 mg with fentanyl 10 μg ; in the tramadol group , patients were given the same dose of bupivacaine with tramadol 10 mg  . Sensory and motor block characteristics , duration of postoperative analgesia , maternal side effects , and neonatal outcome were compared . RESULTS One patient in the tramadol group and two patients in the fentanyl group were excluded from data analysis . Median [ interquartile range ] duration of postoperative analgesia in the tramadol and the fentanyl groups was 300 [ 240 - 360 ] min and 260 [ 233 - 300 ] min respectively ( P = 0.02 ) . The incidence of shivering was lower in patients who received tramadol ( 5 % ) than those who had fentanyl ( 32 % ) ( P = 0.003 ) . Apgar scores , umbilical cord acid-base measurement and neurologic and adaptive capacity scores were comparable between the two groups . CONCLUSION Compared to intrathecal fentanyl 10 μg , tramadol 10 mg , as an adjunct to bupivacaine for subarachnoid block for caesarean section , showed a longer duration of analgesia with a reduced incidence of shivering We performed a prospect i ve , r and omised , double blind study to compare the antishivering effect of morphine and pethidine when added to intrathecal hyperbaric bupivacaine during elective Caesarean delivery under combined‐spinal epidural anaesthesia . Spinal anaesthesia consisted of either 8–10 mg of 0.5 % bupivacaine alone  ( group B ; n = 30 ) with 0.1 mg morphine ( group BM0.1 ; n = 29 ) , with 0.2 mg morphine ( group BM0.2 ; n = 30 ) , or with 10 mg pethidine ( group BPeth10 ; n = 30 ) . The incidences of shivering were 23.3 % ( 7/30 ) in group B , 17 % ( 5/29 ) in group BM0.1 , 13.3 % ( 4/30 ) in group BM0.2 and 3.3 % ( 1/30 ) in group BPeth10 ( p < 0.05 ) . The shivering intensity for each patient was significantly higher in group B than the other groups . In conclusion , intrathecal pethidine added to hyperbaric bupivacaine  reduces the incidence and intensity of shivering more than does morphine ( 0.1 or 0.2 mg ) BACKGROUND AND OBJECTIVES Shivering is a cause of discomfort and dissatisfaction in patients undergoing cesarean section . The objective of this study paper was to assess the impact of intrathecal administration of sufentanil on the incidence of shivering after cesarean section . METHOD In a prospect i ve blinded , r and omized clinical trial , pregnant women undergoing cesarean section under spinal anesthesia were enrolled . Pregnant women in labor , febrile , obese , with pregnancy-induced hypertension , anesthetic block failure or surgical complications were excluded . Patients were r and omly assigned to two groups . In Group I , 10 mg of 0.5 % hyperbaric bupivacaine combined with 80 mcg of morphine and 2.5 mcg of sufentanil were administered . In Group II , 10 mg of 0.5 % hyperbaric bupivacaine combined with 80 mcg of morphine were administered . In the post-anesthesia care unit , patients were evaluated for signs of shivering by an investigator blinded to the patient 's group allocation . RESULTS The sample consisted of 80 patients . In both groups there was a decrease in axillary temperature of patients after cesarean section ( p<0.001 ) . This decrease was not different between groups ( p<0.21 ) . In Group I , the incidence of tremor was 32.5 % ( 13/40 ) and in Group II it was 62.5 % ( 25/40 ) ( p<0.007 ) ; RR 0.53 ( CI 95 % 0.32 - 0.87 ) . CONCLUSIONS It has been suggested that the addition of sufentanil to hyperbaric bupivacaine and morphine during spinal anesthesia for cesarean section provides a decrease in the incidence of shivering in the immediate postoperative period Background and Objectives . Fentanyl at doses of 6.25 μg or more , when added to hyperbaric bupivacaine for spinal anesthesia for cesarean delivery , has been reported to markedly increase the duration of analgesia . In this study , subarachnoid fentanyl 15 μg was evaluated as the sole adjunct to hyperbaric lidocaine spinal anesthesia in parturients undergoing cesarean delivery at term , to determine its effect on the duration of analgesia and side effects perioperatively . Methods . Twenty-eight parturients scheduled for elective cesarean delivery at term were r and omized to one of two groups in a prospect i ve , double-blind fashion . Patients in group F received 15 μg fentanyl in addition to 80 mg hyperbaric lidocaine for subarachnoid anesthesia , while patients in group N received 0.3 mL normal saline in addition to 80 mg hyperbaric lidocaine . Visual analog pain scores were recorded preoperatively and at regular intervals until the first patient request for additional analgesia . The occurrence of side effects ( nausea , vomiting , pruritus , shivering ) was recorded at intervals for 4 hours postinduction . All patients received patient-controlled analgesia after delivery , and analgesic requirements for 24 hours postinduction were recorded . Results . There was no difference between groups with respect to visual analog pain scores intraoperatively . The mean duration of effective analgesia was increased in the patients receiving fentanyl from 71 minutes to 101 minutes ( Student 's t-test , P < .01 ) . No difference was observed between groups with regard to 4-hour or 24-hour analgesic requirements . Patients in group F were significantly less likely to experience nausea ( Fisher 's exact test , P < .05 ) and vomiting ( chi-square test , P < .05 ) in the immediate perioperative period , but no differences were noted between groups in the incidence of pruritus or shivering . Conclusions . The addition of fentanyl 15 μg to hyperbaric lidocaine for subarachnoid anesthesia for cesarean delivery increases the duration of effective analgesia by approximately 30 minutes compared to plain hyperbaric lidocaine , and provides a protective effect regarding nausea and vomiting in the perioperative period Background Shivering is one of the common problems in spinal anesthesia . The objective of the present study was to evaluate the effect of intrathecal fentanyl ( 25 µg ) on incidence and severity of intraoperative and postoperative shivering . Methods A double-blind r and omized controlled study was conducted in eighty healthy women ( ASA Physical status I ) scheduled for elective cesarean section under spinal anesthesia . Subjects were r and omly divided into two equal groups . The patients received 12.5 mg ( 2.5ml ) of 0.5 % hyperbaric bupivacaine combined with 25 µg ( 0.5 ml ) fentanyl in Group F as a study group and 12.5 mg ( 2.5ml ) of 0.5 % hyperbaric bupivacaine combined with 0.5 ml normal saline in Group S as a control group . Incidence of shivering during 30 and 60 minutes of surgery and recovery and complications were evaluated . Results The total incidence of shivering in Group F was significantly lower than Group S ( 10 % in group F ; 75 % in group S , p < 0.0001 ) . Almost all patients started shivering in the first hour after spinal anesthesia and the rate of shivering especially in second 30 minutes was higher than first 30 minutes in both groups . None in Group F but 22 patients ( 55 % ) in Group S had shivering during recovery and all of them reported shivering at the first 30 minute at recovery . The severity of shivering in Group F was significantly lower than Group S ( p < 0.0001 ) . Conclusion Intrathecal bupivacaine combined with fentanyl is associated with a lower incidence and severity of shivering Background : The addition of opioid to local anaesthetics has become a well‐accepted practice of spinal anaesthesia for caesarean delivery . Successful caesarean delivery anaesthesia has been reported with the use of a low dose of intrathecal hyperbaric ropivacaine coadministered with sufentanil . This prospect i ve , double‐blinded study determined the median effective dose ( ED50 ) of intrathecal hyperbaric ropivacaine with and without sufentanil for caesarean delivery , to quantify the sparing effect of sufentanil on the ED50 of intrathecal hyperbaric ropivacaine Introduction Shivering is among the unpleasant and potentially harmful side effects of spinal anesthesia . The aim of this r and omized double-blind clinical trial was to compare the antishivering effect of two different doses of intrathecal pethidine on the incidence and intensity of shivering and other side effects in patients who underwent cesarean section . Methods In this study , 150 parturient females scheduled for nonemergent cesarean section were r and omly allocated to three groups . Spinal anesthesia was performed with 0.5 % hyperbaric bupivacaine ( 12.5 mg ) , plus 0.5 mL of 0.9 % saline in the st and ard group ( S group ) , and the same dose of bupivacaine with 5 mg ( P5 group ) or 10 mg of pethidine ( P10 group ) . Demographic and surgical data , incidence and intensity of shivering ( primary outcome ) , hemodynamic indices , forehead and core temperatures , maximum sensory level , Apgar scores , and adverse events were evaluated by a blinded observer . Results There were no significant differences between the three study groups regarding the demographic and surgical data , hemodynamic indices , core temperatures , and maximum sensory level ( P>0.05 ) . The incidence and intensity of shivering were significantly less in the P5 and P10 groups ( P<0.001 ) when compared with the S group . There were no significant differences between groups for secondary outcomes , except pruritus , which was more common in the P5 and P10 groups when compared with the S group ( P=0.01 ) . Conclusion Low dose of intrathecal pethidine is safe , and can decrease the incidence and intensity of shivering during cesarean section , without having major side effects Background Shivering is among the common troublesome complications of spinal anesthesia ( SA ) , and causes discomfort and discontentment in parturients undergoing cesarean sections ( CSs ) . The aim of this study was to investigate the effects of intrathecal dexmedetomidine in the prevention of shivering in those who underwent CS under SA . Subjects and methods Fifty parturients planned for elective CSs under SA were enrolled in this prospect i ve , double-blinded , controlled study and r and omly divided into two equal groups . Spinal block was achieved with 12.5 mg 0.5 % heavy bupivacaine plus 5 μg dexmedetomidine ( BD group ) or 0.5 mL 0.9 % normal saline ( BN group ) . The incidence and intensity of shivering , peripheral and core body temperature , hemodynamic parameters , and adverse events was recorded . Results The incidence of shivering was significantly higher in the BN group ( 52 % ) than the BD group ( 24 % ) ( P=0.04 ) . Likewise , the intensity of shivering was significantly higher in the BN group than the BD group ( P=0.04 ) . The incidence of adverse events , such as hypotension , nausea/vomiting , and bradycardia , was not significantly different between the two groups , although the grade of sedation was higher in the BD group than the BN group ( P=0.004 ) . Conclusion We conclude that intrathecal dexmedetomidine is effective in lowering the incidence and intensity of shivering in parturients undergoing CSs under SA without major adverse effects Background Regional anesthesia is known to significantly impair thermoregulation and predispose patients to hypothermia . We hypothesized that the addition of an intrathecal injection of magnesium sulfate ( MgSO4 ) to bupivacaine would improve perioperative shivering in female patients undergoing elective caesarean section . Methods In a block-r and omized , double-blinded , controlled trial 72 patients scheduled for elective caesarean section with spinal anesthesia were separated into two groups . In the treatment group , 2 ml of 0.5 % bupivacaine plus 25 mg MgSO4 ( 0.5 ml ) were injected intrathecally , and in the control group 2 ml of 0.5 % bupivacaine plus 0.5 ml normal saline were injected intrathecally . Core temperature was measured before and after drug injection at predetermined intervals . Sedation was grade d using the Ramsay sedation scale . Results No significant intergroup differences in appearance of shivering were seen immediately or at 5 , 30 , 40 , 50 , 60 , and 90 min after block administration . However , at 10 , 15 , and 20 min post block , there was a significant difference in shivering . The group administered MgSO4 showed lower shivering grade s compared with the control group . Core temperature was significantly reduced in the MgSO4 group compared to the normal saline group 30 min after blocking . Conclusions Intrathecal injection of MgSO4 improved perioperative shivering in female patients undergoing elective caesarean section This study was design ed to evaluate the effect of adding dexmedetomidine to regular mixture of epidural drugs for pregnant women undergoing elective cesarean section with special emphasis on their sedative properties , ability to improve quality of intraoperative , postoperative analgesia , and neonatal outcome . Material s and Methods : Fifty women of ASA physical status I or II at term pregnancy were enrolled r and omly to receive plain bupivacaine plus fentanyl ( BF Group ) or plain bupivacaine plus mixture of fentanyl and dexmedetomidine ( DBF Group ) . Incidence of hypotension , bradycardia , Apgar scores , intraoperative pain assessment , onset of postoperative pain , sedation scores , and side effects were recorded . Results : No difference in the times taken for block to reach T4 sensory level , to reach the highest level of sensory block , and interval between first neuraxial injection and onset of surgery between the groups was noted . Onset of postoperative pain was significantly delayed in the DBF group ( P = 0.001 ) , the need for supplementary fentanyl was significantly less in DBF group ( P = 0.03 ) , no significant difference was noted between both groups regarding neonatal Apgar scores as well as the incidence of hypotension , bradycardia , nausea , vomiting , and duration of motor blockade . DBF group had significantly less incidence of shivering ( P = 0.03 ) . Conclusion : Adding dexmedetomidine to regular mixture of epidural anesthetics in women undergoing elective cesarean section improved intraoperative conditions and quality of postoperative analgesia without maternal or neonatal significant side effects OBJECTIVES The aim of this r and omized double-blind study was to investigate whether 20 microg of intrathecally administered fentanyl would influence the incidence and severity of shivering in patients undergoing cesarean section . MATERIAL AND METHOD Sixty healthy patients scheduled for cesarean section under spinal anesthesia using 2.2 ml of 0.5 % hyperbaric bupivacaine with 0.2 ml of morphine 0.2 mg , were r and omly allocated to receive an additional 0.4 ml of fentanyl 20 mg intrathecally ( Group F ) or normal saline 0.4 ml ( Group S ) . RESULTS The incidence of shivering three hours after spinal anesthesia was 6 of 30 patients , 20 % in Group F and 15 of 30 patients , 50 % in Group S. The difference was statistically significant ( p < 0.05 ) . Almost all of the shivering patients started in their first hour after spinal anesthesia ( 5 patients in Group F and 13 patients in Group S ) . None in Group F but 4 patients in Group S started shivering before their babies were delivered . The shivering score was also significantly lower in Group F ( p < 0.05 ) . Treatment for shivering was requested in 16 % and 26 % of the shivering patients in Group F and Group S , respectively . There was no difference in the incidence of pharmacologic side effects . The core temperature did not differ significantly between the groups during 3 hours after spinal anesthesia . CONCLUSION The addition of 20 microg fentanyl in 2.2 ml of 0.5 % hyperbaric bupivacaine with 0.2 ml of morphine 0.2 mg intrathecally can reduce the incidence and severity of intraoperative and postoperative shivering after spinal anesthesia for patients who were receiving cesarean section without increasing other side effects Background : So far only ropivacaine concentrations of 0.5 and 0.75 % have been used for Caesarean section . This prospect i ve double‐blind trial evaluated the anaesthetic quality of ropivacaine 1 % with and without sufentanil addition To compare the effects of intrathecal dexmedetomidine and intrathecal morphine as supplements to bupivacaine in cesarean sections under spinal anesthesia . Full-term parturients ( n=120 ) undergoing elective cesarean sections under spinal anesthesia were r and omly allocated into three groups : Group B received 10 mg bupivacaine , Group BD received 10 mg bupivacaine plus 5 µg dexmedetomidine , and Group BM received 10 mg bupivacaine plus 100 µg morphine .  The onset and regression time of sensory and motor blockade , postoperative analgesia , and side effects were recorded . Group BD showed quicker onset time and a longer sensory and motor blockade than other groups ( BD vs. B and BD vs. BM , p<0.05 ) . The mean time of sensory regression to the S1 segment was 253.21±42.79 min in group BD , 192.50±40.62 min in group BM and 188.33±37.62 min in group B ( p<0.001 ) . Group BD showed an analgesia duration ( time to requirement of first rescue analgesic ) ( 17.59±6.23 h ) similar to that of group BM ( 16.78±5.90 h ) but longer than that of group B ( 3.53±1.68 h ) ( p<0.001 ) . The incidence of pruritus was significantly higher in group BM compared with groups BD and B ( p<0.001 ) . Less shivering was observed in group BD than in groups BM and B ( p=0.009 ) . So intrathecal dexmedetomidine ( 5 µg ) prolonged the motor and sensory blockade , provided a similar analgesic effect and reduced pruritus and shivering compared with morphine ( 100 µg ) in cesarean sections The effects of shivering on hemodynamics and systemic oxygenation , as well as the effectiveness of therapeutic interventions in decreasing shivering and increasing mixed venous oxygen saturation , were studied . Thirty adult patients undergoing cardiopulmonary bypass with systemic hypothermia were observed for 1 1/2 to 5 hours postoperatively for signs of shivering associated with a simultaneous decrease in oxygen transport . Systemic and pulmonary hemodynamic measurements were made , blood temperature and mixed venous oxygen saturation were monitored via the pulmonary arterial catheter , and oxygen consumption and delivery were calculated . Shivering was grade d by a single investigator on scale of 0 to 4 , with 0 = no shivering and 4 = continuous violent muscle activity . Therapy was instituted when shivering reached grade 4 or when SvO2 decreased to less than two thirds of its value on arrival in the intensive care unit ( ICU ) . Patients were r and omly assigned to receive either morphine sulfate , 5 to 10 mg , or meperidine , 25 to 50 mg intravenously ( IV ) , followed by the other narcotic if the initial drug failed to improve SvO2 or decrease shivering within ten minutes . The end-point for successful treatment was a return of SvO2 to within 5 % to 10 % of its value upon arrival in the ICU or a cessation of shivering that did not recur within 45 minutes . Twenty of the thirty patients shivered sufficiently to decrease SvO2 by more than one third of its initial value , thus requiring pharmacologic therapy . As shivering increased from a score of 0.8 + /- 1.1 to 3.4 + /- 0.9 , SvO2 decreased from 74 + /- 6 % to 57 + /- 12 % . ( ABSTRACT TRUNCATED AT 250 WORDS BACKGROUND Combined spinal-epidural anaesthesia is commonly used for elective caesarean section . Intrathecal injection produces rapid onset with minimal doses of local anaesthetic and epidural administration can be used to prolong the block . Our study examined the effects of adding magnesium sulphate to epidural bupivacaine and fentanyl in patients undergoing elective caesarean section using combined spinal-epidural anaesthesia . METHODS Women ASA physical status I or II at term were recruited . All received 2 mL intrathecal 0.5 % hyperbaric bupivacaine , 10 mL epidural 0.25 % plain bupivacaine with fentanyl 100 μg , and were r and omly allocated to receive either 10 mL of epidural 0.9 % sodium chloride or 10 mL epidural 5 % magnesium sulphate .  The quality of surgical anaesthesia , incidence of hypotension , Apgar scores , intraoperative pain assessment , onset of postoperative pain , sedation scores and side effects were recorded in the postoperative period . RESULTS Ninety women were recruited . There was no difference in the time taken for the block to reach T4 sensory level , time to reach the highest level of sensory block , time interval between first neuraxial injection and onset of surgery between the groups . Women who received magnesium had greater motor block and muscle relaxation ( P<0.05 ) . Apgar scores were 7 or more in almost all neonates in both groups . There was no significant difference in the incidence of hypotension , nausea and vomiting and duration of motor blockade between the groups . Women who received magnesium showed less shivering and later onset of post operative pain ( P<0.05 ) . CONCLUSION The addition of magnesium to epidural bupivacaine and fentanyl in women undergoing elective caesarean section with combined spinal-epidural anaesthesia improved intraoperative conditions and the quality of postoperative analgesia Background and Context : Different adjuvants been tried out for neuraxial anesthesia in emergency caesarean section so that the dose of the local anesthetic can be reduced and hypotension thereby prevented . Aims and Objectives : The present study was carried out in patients presenting for emergency lower segment caesarean section ( LSCS ) to establish the dose of intrathecal clonidine that would allow reduction of the dose of local anesthetic ( thereby reducing the incidence and magnitude of hypotension ) while at the same time providing clinical ly relevant prolongation of spinal anesthesia without significant side effects . Material s and Methods : This r and omized clinical study was carried out in our institution among 100 pregnant females who underwent emergency caesarean section .  The participants were divided r and omly into four groups : A , B , C , and D , each comprising 25 parturients . Subarachnoid block was performed using a 26 G Quincke needle , with 12 mg of hyperbaric bupivacaine ( LA ) in group A , 9 mg of LA + 30 μg of clonidine in group B , LA + 37.5 μg of clonidine in group C , and LA + 45 μg of clonidine in group D. The solution was uniformly made up to 2.2 mL with normal saline in all the groups . Onset of analgesia at T10 level , sensory and motor blockade levels , maternal heart rate and blood pressure , neonatal Apgar scores , postoperative block characteristics , and adverse events were looked for and recorded . Statistical analysis was carried out with SPSS ® version 10.0 for Windows ® , using the ANOVA test with post hoc significance , the Chi-square test , and the Mann-Whitney U test . P<.05 was considered significant and P<.0001 as highly significant . Results : One hundred patients were enrolled for this study . The four groups were comparable with regard to demographic data and neonatal Apgar scores . Onset and establishment of sensory and motor analgesia was significantly shorter in groups C and D , while hypotension ( and the use of vasopressors ) was significantly higher in groups A and D. Perioperative shivering , nausea , and vomiting were significantly higher in groups A and D , while incidence of dry mouth was significantly higher in group D. Conclusions : The addition of 45 μg , 37.5 μg , and 30 μg of clonidine to hyperbaric bupivacaine results in more prolonged complete and effective analgesia , allowing reduction of up to 18 % of the total dose of hyperbaric bupivacaine . From the results of this study , 37.5 μg of clonidine seems to be the optimal dose Background : Subarachnoid block is the preferred technique for providing anesthesia for patients undergoing cesarean section . Various pharmacological agents in added to local anesthetics ( LA ) modify their original effects in terms of block characteristics and quality of analgesia . However , there is ongoing debate about this practice of using adjuncts with LA . We tested whether addition of lipophilic versus lipophobic opioids to LA gives any clinical benefits to maternal and fetal outcome when used in these patients requiring spinal anesthesia . Subjects and Methods : Sixty American Society of Anesthesiologists I and II parturients , undergoing elective cesarean section requiring subarachnoid block , were included in our study . The parturients were allocated r and omly to three groups of 20 each to receive bupivacaine 12.5 mg ( Group I ) , bupivacaine 12.5 mg + morphine 0.2 mg ( Group II ) , bupivacaine 12.5 mg + fentanyl 25 μg ( Group III ) , preservative free physiological saline 0.9 % was added to all the solutions to achieve a total volume of 4 ml . The parameters studied were the time of onset , sensory level of the block achieved , total duration of analgesia , any need of rescue analgesics , maternal side effects , and fetal outcome . Results : Onset of block was early 4.30 ± 0.12 min in Group III as compared to Group I 4.64 ± 0.28 min and Group II 4.505 ± 0.22 min . Mean duration of analgesia ( hours ) was higher in Group II 15.91 ± 0.96 h as compared to Group I 1.95 ± 0.55 h and Group III 4.39 ± 0.2 h. Incidence of nausea , vomiting , and shivering was more in the control group as compared to study groups , whereas sedation and pruritus were seen more in the study groups . No adverse effects on fetus were seen with use of opioids and comparable Apgar scores were noted . Conclusion : Addition of intrthecal fentanyl causes rapid onset of block whereas intrathecal morphine provides prolonged analgesia with comparable neonatal wellbeing Background and objective 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 prospect i ve r and omised double-blinded study was conducted to compare the antishivering effects of two different doses of intrathecal meperidine . Methods 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 . Results 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 . Conclusion The use of intrathecal meperidine for caesarean section during spinal anaesthesia for the prevention of shivering can not be recommended as its use is associated with increased incidence of nausea and vomiting This prospect i ve , controlled study was undertaken to determine whether addition of adrenaline or fentanyl to bupivacaine or warming of the injectate had any effect on the incidence of  shivering following extradural analgesia in the labouring parturient . Eighty-four patients were sequentially allocated to four groups ( control , warm injectate , extradural adrenaline and extradural fentanyl ) . The adrenaline group had the highest incidence of shivering , the warm injectate and fentanyl groups the lowest . Extradural fentanyl also seemed promising in reducing shivering in pre-block shiverers . This paper also explores the rapidity of temperature decay of solutions of bupivacaine  in different clinical situations OBJECTIVE To explore the anesthetic effect and neonatal effects of dexmedetomidine combined with ropivacaine in the cesarean section under epidural anesthesia . METHODS Between January 2012 and March 2013 at the First Affiliated Hospital with Nanjing Medical University , sixty parturients with a single baby at full term in vertex presentation scheduled for caesarean section under epidural anesthesia , were r and omly divided into 3 groups ( n = 20 each ) according to the r and om digits table : dexmedetomidine + ropivacaine ( RD ) , fentanyl + ropivacaine ( RF ) and normal saline + ropivacaine ( RN ) . After identification of the epidural space and a negative aspiration test for blood or cerebrospinal fluid , 15 ml of 0.75 % ropivacaine , was administered epidurally in three the groups with addition of 1 µg/kg of dexmedetomidine in RD group , 1 µg/kg of fentanyl in RF group and 2 ml of normal saline in RN group . Recording the mean arterial pressure ( MAP ) and heat rate ( HR ) before anesthesia ( T(0 ) ) , at 10 min ( T(1 ) ) and 30 min ( T(2 ) ) after the end of epidural administration , and at end of operation ( T(3 ) ) . Recording the onset time , maximum sensory analgesic level , time to maximum sensory analgesic level , time to two segmental dermatomal regressions , and time to chief complaint of postoperative pain . The modified bromage degrees , sedation scores and traction reaction were also assessed . The Apgar scores at 1 and 5 min were also recorded after delivery , and the blood sample s were drawn from umbilical vein for gas analysis . RESULTS MAP , HR and the motor block ( Bromage scale ) were no statistics differences among the three groups ( P > 0.05 ) . Compared with RN group , the onset time and the time to maximum sensory analgesic level were significantly earlier [ ( 6.3 ± 2.4 ) , ( 8.7 ± 2.3 ) min vs ( 10.9 ± 2.7 ) min ; ( 11.5 ± 3.9 ) , ( 16.2 ± 4.6 ) min vs(19.8 ± 5.2 ) min , P < 0.05 ] , the time to two segmental dermatomal regressions and the time to chief complaint of postoperative pain were prolonged significantly[(22.5 ± 4.6 ) , ( 18.5 ± 3.9 ) min vs ( 13.5 ± 3.8 ) min ; ( 415 ± 92 ) , ( 355 ± 86 ) min vs ( 273 ± 68 ) min , P < 0.05 ] , level of sedation and degree of traction reaction were better in RD group and in RF group , and the incidence of shivering was lower in RD group ( 5 % vs 40 % , P < 0.05 ) , the incidence of dizziness was higher in RF group ( 20 % vs 0 , P < 0.05 ) . Compared with RF group , the same results were also seen about the onset time , the time to maximum sensory analgesic level , the time to two segmental dermatomal regressions and the time to chief complaint of postoperative pain , and the level of sedation was better , the incidence of drowsiness was lower in RD group . There were no statistics differences about both the blood gas analysis of umbilical vein and the Apgar scores at 1 and 5 min after delivery . CONCLUSION Administration of dexmedetomidine combined with ropivacaine can provide early onset , establishment of sensory anesthesia , much better sedation levels , decrease the degree of traction reaction and the incidence of shivering , and without adverse neonatal effects BACKGROUND It is well known that intrathecal opioids have a synergic effect with spinal local anaesthetics . The aim of this study was to evaluate whether low-dose ropivacaine in combination with sufentanil could produce effective spinal anaesthesia with less maternal hypotension and vomiting than ropivacaine alone . METHODS 80 ASA I and II parturients undergoing elective caesarean delivery under combined spinal-epidural anaesthesia were r and omly allocated to two groups . Group R15 received intrathecal hyperbaric ropivacaine 15 mg and group SR10 hyperbaric ropivacaine 10 mg with sufentanil 5 micrograms .  Characteristics , efficacy and side effects of spinal anaesthesia in each group were measured . RESULTS There was no significant difference in the quality of intraoperative analgesia and muscle relaxation between groups . The incidence of hypotension was significantly higher ( 55 % vs. 20 % , P < 0.005 ) and the need for ephedrine less in group R15 than in group SR10 . In group SR10 , the onset of motor block was delayed ( 2.9 + /- 1.1 vs. 4.6 + /- 2.5 min , P < 0.005 ) , the duration was shorter ( 65.9 + /- 15.1 vs. 125.4 + /- 26.4 min , P < 0.005 ) . The duration of effective analgesia was longer ( 260 + /- 32.5 vs. 143 + /- 22.1 min , P < 0.005 ) , the incidence of shivering ( 20 % vs. 60 % , P < 0.005 ) and vomiting ( 5 % vs. 30 % , P < 0.005 ) were lower in group SR10 . CONCLUSIONS The combination of hyperbaric ropivacaine 10 mg with sufentanil 5 lg produced effective spinal anaesthesia for caesarean delivery with significantly less hypotension , vomiting and shivering , shorter duration of motor blockade and longer lasting analgesia than hyperbaric ropivacaine 15 mg OBJECTIVE To determine if systematic use of metoclopramide associated with opioids ( Morphine sulfate SR ) decreases the incidence of nausea and vomiting ( N&V ) , established adverse effects of opioids . METHOD Open r and omised study with 132 patients treated for non malignant pain ( 71 women , 61 men , mean age 53.4 years ) . One group ( n = 76 ) was treated with morphine alone ; the other ( n = 56 ) with morphine plus metoclopramide . Mean duration of therapy : 6 days ; mean dosage : 60 mg/d RESULTS In the 2 groups , N&V were present in the first 72 hours . The frequency of N&V in the morphine group was 38.1 % ( conform with the literature ) . The systematic use of metoclopramide decreases the frequency of N&V : p < 0.005 . However the use of morphine > 60 mg/d decreases N&V : p = 0.036 . High dosages of morphine can have an antiemetic effect by interaction with the mu receptors in the antiemetic center and not in the trigger zone which has an emetic effect . CONCLUSION The systematic use of metoclopramide with opioid therapy for non malignant pain in rheumatology decreases the risk of nausea and vomiting Shivering associated with spinal anesthesia is uncomfortable and may interfere with monitoring . We performed this prospect i ve , double-blinded , and r and omized study to determine whether intrathecal meperidine ( 0.2 mg/kg ) decreases the incidence and intensity of shivering after spinal anesthesia for cesarean delivery . Forty parturients scheduled for nonemergent cesarean delivery were enrolled in two groups .  Spinal anesthesia consisted of hyperbaric bupivacaine ( 0.75 % ; 10.5 mg ) , morphine 0.15 mg , and , in the experimental group , meperidine ( 0.2 mg/kg ) or , in the control group , normal saline . Data collection , including sensory block level , blood pressure , core temperature , and shivering intensity , was performed every minute for 10 min , every 3 min for 33 min , and then every 5 min until the sensory level receded to L4 . Time to highest sensory level , maximum number of blocked segments , sensory and motor blockade regression , and systolic blood pressure showed no difference between groups . The incidence of shivering was less ( P < 0.02 ) in the meperidine group , as was its intensity ( P < 0.003 ) . Intrathecal meperidine ( 0.2 mg/kg ) is effective in reducing the incidence and intensity of shivering associated with spinal anesthesia for cesarean delivery
target: The results showed that , compared with placebo , pethidine , fentanyl , dexmedetomidine , and sufentanil significantly reduced the incidence of perioperative shivering .
  In addition , compared with sufentanil , fentanyl showed no impact on haemodynamic stability and the incidence of pruritus .
  CONCLUSION Pethidine , fentanyl , dexmedetomidine , and sufentanil appear to be effective for preventing perioperative shivering in puerperae undergoing cesarean sections .
  Considering the risk-benefit profiles of the included neuraxial adjuvants , fentanyl is probably the optimal choice
background: BACKGROUND Perioperative shivering is clinical ly common during cesarean sections under neuraxial anesthesia , and several neuraxial adjuvants are reported to have preventive effects on it .
  However , the results of current studies are controversial and the effects of these neuraxial adjuvants remain unclear .
  AIM To evaluate the effects of neuraxial adjuvants on perioperative shivering during cesarean sections , thus providing an optimal choice for clinical application .