<abstract xmlns="http://www.w3.org/1999/xhtml">

Perioperative shivering is a well-known complication reported in 29 to 54% of patients undergoing a caesarean section under regional anaesthesia. It interferes with pulse oximetry, blood pressure (BP), and electrocardiographic monitoring (ECG). Moreover, it gives the patient a distressing and unpleasant experience. This review aims to examine the mechanism of shivering during the caesarean section under neuraxial anaesthesia and to explore available information for preventing and managing this clinically significant complication.
A literature search of PubMed, MedLine, Science Direct, and Google Scholar was done. The search results were limited to randomised controlled trials (RCT) and systematic reviews.
This review studied the efficacy of various nonpharmacological and pharmacological methods to manage perioperative shivering. We found that pre-warming and intraoperative warming are simple and effective interventions, although the effect seems to depend on the duration of treatment. Multiple pharmacological interventions, including opioids, NMDA receptor antagonists, and alpha-2 adrenergic agonists, have been studied and found to reduce the incidence and severity of perioperative shivering during caesarean section under neuraxial anaesthesia.
</abstract>

Perioperative shivering is a well-known complication reported in 29 to 54% of patients undergoing a caesarean section under regional anaesthesia. It interferes with pulse oximetry, blood pressure (BP), and electrocardiographic monitoring (ECG). Moreover, it gives the patient a distressing and unpleasant experience. This review aims to examine the mechanism of shivering during the caesarean section under neuraxial anaesthesia and to explore available information for preventing and managing this clinically significant complication.
A literature search of PubMed, MedLine, Science Direct, and Google Scholar was done. The search results were limited to randomised controlled trials (RCT) and systematic reviews.
This review studied the efficacy of various nonpharmacological and pharmacological methods to manage perioperative shivering. We found that pre-warming and intraoperative warming are simple and effective interventions, although the effect seems to depend on the duration of treatment. Multiple pharmacological interventions, including opioids, NMDA receptor antagonists, and alpha-2 adrenergic agonists, have been studied and found to reduce the incidence and severity of perioperative shivering during caesarean section under neuraxial anaesthesia.

Narrative Review on Perioperative Shivering during Caesarean Section under Neuraxial Anaesthesia

Department of Anesthesia and Perioperative Medicine, Schulich School of Medicine

Romanian Journal of Anaesthesia and Intensive Care

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

Perioperative shivering is a well-known complication reported in 29 to 54% of patients undergoing a caesarean section under regional anaesthesia. It interferes...

	Mechanism	Remark
Opioid	Mu and Kappa receptor agonism, anticholinergic action, monoamine reuptake inhibition	Effective at reducing the incidence and severity of perioperative shivering
Meperidine 10 mg ITFentanyl 20 – 25 μg ITTramadol 10 mg IT
5-HT3 Antagonist	Inhibit serotonin reuptake at the pre-optic anterior hypothalamic region	May be effective when compared to inactive placebo but not when compared to intrathecal fentanyl
Ondansetron 8 mg IV
NMDA Antagonist	Modulate noradrenergic and serotonergic neurons in the locus coeruleus	Ketamine appears effective while evidence on magnesium is limited
Ketamine 0.25 – 0.5 mg/kg IVMagnesium Sulphate 50 mg Epid
Alpha-2 Agonist	Alpha-2 receptor stimulation decreases the thermoregulatory threshold for shivering at the hypothalamus level, and modulate cutaneous thermal inputs via descending inhibition, thus inhibiting shivering at the spinal cord level	Dexmedetomidine is effective at reducing shivering but can lead to bradycardia
Dexmedetomidine 5 – 10 μg ITDexmedetomidine 1 μg/kg EpidDexmedetomidine 30 mcg IV

	Example	Mechanism	Remark
Prewarming	Blanket, forced-air warmer, warmed IV fluids	Increases body surface heat content and reduces heat loss from redistribution	Active warming is more effective than passive warming
Intraoperative warming	Forced-air warmer, warmed IV fluids	Reduces core-to-surface heat loss	Lower body forced-air warmer is more effective than upper body

Narrative Review on Perioperative Shivering during Caesarean Section under Neuraxial Anaesthesia

Article Category: Review

Published Online: Jan 14, 2023

Page range: 41 - 46

DOI: https://doi.org/10.2478/rjaic-2022-0006

Keywords
Neuraxial anaesthesia, caesarean section, perioperative shivering

© 2022 Kamal Kumar et al., published by Sciendo

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

Pharmacological methods of preventing perioperative shivering

Nonpharmacological methods of preventing perioperative shivering

Narrative Review on Perioperative Shivering during Caesarean Section under Neuraxial Anaesthesia

Article Category: Review

Published Online: Jan 14, 2023

Page range: 41 - 46

DOI: https://doi.org/10.2478/rjaic-2022-0006

KeywordsNeuraxial anaesthesia, caesarean section, perioperative shivering

© 2022 Kamal Kumar et al., published by Sciendo

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

Pharmacological methods of preventing perioperative shivering

Nonpharmacological methods of preventing perioperative shivering

Keywords
Neuraxial anaesthesia, caesarean section, perioperative shivering