The effects of different doses of intrathecal meperidine on the incidence and severity of shivering during lower extremity orthopedic surgery under spinal anesthesia: A randomized, placebo-controlled, double blind-clinical trial


Anesthesiology and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran


Background: Shivering associated with spinal anesthesia is a common complication. It also causes more usage of oxygen, increased production of carbon dioxide (CO2), and lactic acidosis with movement of clots and bleeding after surgery. This study was performed to compare the different dosages of intrathecal meperidine and their effects on shivering during and after surgery and to compare these to the control group.
Materials and Methods: This study is a clinical trial. Target population consisted of the patients who were candidates for lower limb orthopedic surgery under spinal anesthesia. About 120 patients were chosen and randomly divided into four groups. In group 1, spinal anesthesia was performed with 3 ml marcaine 0.5% and 0.1 mg/kg meperidine. In group 2, 3 ml marcaine 0.5% and 0.2 mg/kg meperidine was given. In group 3, 3 ml marcaine 0.5% and 0.3 mg/kg meperidine, and in the fourth group, 3 ml marcaine 0.5% and normal saline in the same volume were injected. During surgery and recovery, hemodynamic index and shivering were recorded.
Results: Based on the analyzed data, in the fourth group 23 patients (76.7%) had shivering. While the prevalence of shivering in the first, second, and third groups was 15 patients (50%), 11 patients (36.7%), and 3 patients (10%), respectively. Chi-square test showed significant difference in the four groups (P < 0.001).
Conclusions: Using higher dosage of intrathecal meperidine (0.3 mg/kg) was more effective than using lower dosage of meperidine (0.1 mg/kg and 0.2 mg/kg) in reducing the incidence and severity of shivering during spinal anesthesia in lower extremity orthopedic surgeries.


Chen JC, Hsu SW, Hu LH, Hong YJ, Tsai PS, Lin TC, et al. Intrathecal meperidine attenuates shivering induced by spinal anesthesia. Ma Zui Xue Za Zhi 1993;31:19-24.  Back to cited text no. 1
Macintyre PE, Pavlin EG, Dwersteg JF. Effect of meperidine on oxygen consumption, carbon dioxide production, and respiratory gas exchange in postanesthesia shivering. Anesth Analg 1987;66:751-5.  Back to cited text no. 2
Piper SN, Fent MT, Ro¨hm KD, Maleck WH, Suttner SW, Boldt J. Urapidil does not prevent postanesthetic shivering: A dose-ranging study. Can J Anaesth 2001;48:742-7.  Back to cited text no. 3
Tsai YC, Chu KS. A comparison of tramadol, amitriptyline, and meperidine for postepidural anesthetic shivering in parturients. Anesth Analg 2001;93:1288-92.  Back to cited text no. 4
Morgan GE, Mikhail MS, Murray MJ. Anesthesia for genitourinary surgery. In: Murray MJ, Morgan GE, Mikhail MS, editors. Clinical anesthesiology. 3 rd ed. New York: McGraw-Hill; 2002. p. 695-6.  Back to cited text no. 5
Matsukawa T, Sessler DI, Christensen R, Ozaki M, Schroeder M. Heat flow and distribution during epidural anesthesia. Anesthesiology 1995;83:961-7.  Back to cited text no. 6
Kurz A, Sessler DI, Schroeder M, Kurz M. Thermoregulatory response thresholds during spinal anesthesia. Anesth Analg 1993;77:721-6.  Back to cited text no. 7
Ozaki M, Kurz A, Sessler DI, Lenhardt R, Schroeder M, Moayeri A, et al. Thermoregulatory thresholds during epidural and spinal anesthesia. Anesthesiology 1994;81:282-8.  Back to cited text no. 8
Alfonsi P, Sessler DI, Du Manoir B, Levron JC, Le Moing JP, Chauvin M. The effects of meperidine and sufentanil on the shivering threshold in postoperative patients. Anesthesiology 1998;89:43-8.  Back to cited text no. 9
Monso A, Riudeubas J, Barbal F, Laporte JR, Arnau JM. A randomized, double-blind, placebo-controlled trial comparing pethidine to metamizol for treatment of post-anaesthetic shivering. Br J Clin Pharmacol 1996;42:307-11.  Back to cited text no. 10
Patel D, Janardhan Y, Merai B, Robalino J, Shevde K. Comparison of intrathecal meperidine and lidocaine in endoscopic urological procedures. Can J Anaesth 1990;37:567-70.  Back to cited text no. 11
Hansen D, Hansen S. The effects of three graded doses of meperidine for spinal anesthesia in African men. Anesth Analg 1999;88:827-30.  Back to cited text no. 12
Norris MC, Honet JE, Leighton BL, Arkoosh VA. A comparison of meperidine and lidocaine for spinal anesthesia for postpartum tubal ligation. Reg Anesth 1996;21:84-8.  Back to cited text no. 13
Sangarlangkarn S, Klaewtanong V, Jonglerttrakool P, Khankaew V. Meperidine as a spinal anesthetic agent: A comparison with lidocaine-glucose. Anesth Analg 1987;66:235-40.  Back to cited text no. 14
Tauzin-Fin P, Maurette P, Vincon G, Hecquet D, Houdek MC, Bonnet F. Clinical and pharmacokinetic aspects of the combination of meperidine and prilocaine for spinal anaesthesia. Can J Anaesth 1992;39:655-60.  Back to cited text no. 15
Pauca AL, Savage RT, Simpson S, Roy RC. Effect of pethidine, fentanyl and morphine on post-operative shivering in man. Acta Anaesthesiol Scand 1984;28:138-43.  Back to cited text no. 16
Guffin A, Girard D, Kaplan JA. Shivering following cardiac surgery: Hemodynamic changes and reversal. J Cardiothorac Anesth 1987;1:24-8.  Back to cited text no. 17
Kurz M, Belani KG, Sessler DI, Kurz A, Larson MD, Schroeder M, et al. Naloxone, meperidine, and shivering. Anesthesiology 1993;79:1193-201.  Back to cited text no. 18
Wang JJ, Ho ST, Lee SC, Liu YC. A comparison among nalbuphine, meperidine, and placebo for treating postanesthetic shivering. Anesth Analg 1999;88:686-9.  Back to cited text no. 19
De Witte J, Sessler DI. Perioperative shivering: Physiology and pharmacology. Anesthesiology 2002;96:467-84.  Back to cited text no. 20
Roy JD, Girard M, Drolet P. Intrathecal meperidine decreases shivering during cesarean delivery under spinal anesthesia. Anesth Analg 2004;98:230-4.  Back to cited text no. 21
Davoudi M, Mousavi-Bahar H, Farhanchi A. Intrathecal meperidine for prevention of shivering during transurethral resection of prostate. Urol J 2007;4:212-6.  Back to cited text no. 22
Anaraki AN, Mirzaei K. The effect of different intrathecal doses of meperidine on shiverering during delivery under spinal anesthesia. Int J Prev Med 2012;3:706-12.  Back to cited text no. 23
[PUBMED]  Medknow Journal  
Chun DH, Kil HK, Kim HJ, Park C, Chung KH. Intrathecal meperidine reduces intraoperative shivering during transurethral prostatectomy in elderly patients. Korean J Anesthesiol 2010;59:389-93.  Back to cited text no. 24