Effect of temperature variation of intrathecal Bupivacaine on shivering in parturients undergoing spinal anaesthesia

Abstract

Introduction: Shivering associated with neuraxial anesthesia is a frequent complication that occurs in up to 55% of patients. Shivering is uncomfortable for the patient and may interfere with the monitoring of electrocardiogram, blood pressure (BP), and oxygen saturation. The metabolic and hemodynamic consequences of shivering include increased disbursement of cardiac and systemic energy, increased oxygen consumption and carbon dioxide production, and increased cardiac work.Materials and Methods: After obtaining institutional ethics committee approval and written informed consent from patients, this prospective randomised double blind study was conducted on 80 parturients posted for elective Caesarian Section (CS) at a tertiary care centre from January 2019 to January 2020. 80 patients randomized into Group I and Group II with 40 members in each group, Group I receiving 2 ml of 0.5% heavy Bupivacaine at 22oC and Group II 2 ml of 0.5% heavy bupivacaine at 37oc for spinal anesthesia. Sample size was calculated on the basis of observed shivering proportion during CS in our hospital.Results: Shivering was present in 57.5 % of patients in group I and 32.5 % in group II and this difference was statistically significant and overall shivering percentage was 45 %, although difference in mean onset of time was not significant in two groups. The grades of shivering were comparable in both groups. There was no significant difference in incidence of bradycardia, hypotension, nausea and vomiting in two groups.Conclusion:Shivering remains a common concern in patients operated for caesarean section under neuraxial anaesthesia causing discomfort to parturients. Several pharmacological and non-pharmacological measures have been tried to prevent and treat it and there is no gold standard treatment defined for it. The present study demonstrates lesser incidence of shivering with warm local anaesthetic solution injected intrathecally without any difference in incidence of level of blockade and incidence of adverse effects.