Effect of Low Dose Intrathecal Pethidine on Incidence and Intensity of Shivering During Caesarean Section Under Spinal Anaesthesia:An Observational Study

Abstract

Background
Shivering is a frequent and distressing complication during Cesarean Sections (CS) under spinal anesthesia, affecting over 40% of patients. It compromises maternal comfort, increases metabolic demand, and may lead to adverse hemodynamic effects, delayed recovery, and postoperative complications. While various interventions exist, their efficacy and safety remain inconsistent. Low-dose intrathecal pethidine, a synthetic opioid with anti-shivering properties via kappa and mu receptor modulation, offers a promising preventive approach. This study assessed its efficacy and safety
in elective CS under spinal anesthesia. 

Methods
A hospital-based interventional comparative study was conducted at Nepal Medical College Teaching Hospital, enrolling 100 ASA II parturients aged 18–40 years scheduled for elective CS. Participants were randomized into two groups: Group B (n=50) received intrathecal bupivacaine (10 mg), while Group P (n=50) received bupivacaine (10 mg) plus pethidine (10 mg). Hemodynamic parameters, shivering incidence (graded 0–4 using the Crossley and Mahajan scale), neonatal Apgar scores, and side effects were recorded. 

Results
Results demonstrated a significant reduction in shivering with pethidine (0% in Group P vs. 44% in Group B, p < 0.001), with no severe shivering in Group P.Hemodynamic stability was maintained in both groups, with no clinically significant differences in blood pressure, heart rate, or oxygen saturation. Neonatal outcomes were comparable, with similar Apgar scores at 1 and 5 minutes. Side effects (hypotension, bradycardia, nausea, vomiting, pruritus) were minimal and manageable, with no major adverse events.

Conclusions
Low-dose intrathecal pethidine effectively prevents shivering without compromising maternal or neonatal safety. Its dual receptor action and favorable side effect profile make it a valuable adjunct in spinal anesthesia for CS, enhancing perioperative comfort. Further large-scale studies are warranted to confirm these findings and establish its role in obstetric anesthesia practice.