Prophylactic Intrathecal Versus Intravenous Meperidine for Shivering After Spinal Anesthesia in Elective Cesarean Section: A Three-Arm, Randomized, Double-Blind, Placebo-Controlled Trial

Masaeli, Milad; Sin Darreh, Setayesh; Nazem Roaya, Behzad; Mahdavi Far, Fateme

doi:10.48305/jims.2026.46506.3061

Prophylactic Intrathecal Versus Intravenous Meperidine for Shivering After Spinal Anesthesia in Elective Cesarean Section: A Three-Arm, Randomized, Double-Blind, Placebo-Controlled Trial

Articles in Press

Document Type : Original Article(s)

Authors

Milad Masaeli ¹

Setayesh Sin Darreh ²

Behzad Nazem Roaya ³

Fateme Mahdavi Far ⁴

¹ Department of Anesthesiology and Critical Care, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.

² Isfahan University of Medical Sciences, Isfahan, Iran, Epidemiology and Biostatistics Department, Health School

³ Anesthesiology and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.

⁴ Student Research Committee, Isfahan University of Medical Sciences, Isfahan, Iran

10.48305/jims.2026.46506.3061

Abstract

Background: Postoperative shivering is a frequent and distressing complication following spinal anesthesia in cesarean sections, with significant physiological consequences. Meperidine has been proposed as an effective prophylactic agent, but the optimal route of administration remains under investigation/the aim of this study was to compare the prophylactic efficacy and safety of low-dose intrathecal meperidine versus intravenous meperidine and placebo for the prevention of shivering in elective cesarean sections under spinal anesthesia.
Methods: In this randomized, double-blind, placebo-controlled trial, 151 parturients (ASA physical status II, aged 18–47) scheduled for elective cesarean section under spinal anesthesia were allocated into three groups: the Intrathecal Meperidine group (MEP-IT, n=49; receiving 12/5"-" 15" mg" hyperbaric bupivacaine plus 0/1" mg/kg" intrathecal meperidine, and 1" mL" IV normal saline), the Intravenous Meperidine group (MEP-IV, n=51; receiving bupivacaine intrathecally plus 0/3" mg/kg" IV meperidine), and the Control group (n=51; receiving bupivacaine intrathecally plus IV normal saline)/ Shivering incidence, severity (graded 0–4), hemodynamic parameters, and core temperature were monitored for 60 minutes.

Keywords

Cesarean Section

Spinal Anesthesia

Postoperative Shivering

Meperidine

Injections

Intrathecal

Intravenous Injection

Subjects