Postoperative Shivering Management in Anesthesia

Postoperative shivering is a common and distressing complication following general and regional anesthesia. It arises from impaired thermoregulation and heat redistribution, manifesting as involuntary muscle activity that increases oxygen consumption, carbon dioxide production and cardiac workload. Effective management encompasses both non-pharmacological measures—such as active warming devices and warmed intravenous fluids—and pharmacological interventions. Agents including opioids, serotonin receptor antagonists and α2-adrenoceptor agonists have been evaluated for their efficacy in preventing and treating shivering. Optimising anaesthetic techniques, monitoring core temperature and tailoring prophylactic medication according to patient risk factors are central to minimising the incidence and severity of shivering, thus improving patient comfort and reducing metabolic and haemodynamic disturbances.

Research from Nature Portfolio

Recent systematic analyses have quantified the benefits and risks of low-dose intrathecal meperidine as an adjuvant during spinal anesthesia. Meta-analytic methods with trial sequential analysis confirm that doses between 0.05 and 0.5 mg kg⁻¹ significantly reduce the incidence of shivering and decrease requirements for intraoperative rescue analgesia. The robust evidence base also demonstrates no increase in pruritus, while highlighting a modest rise in nausea and vomiting. These findings establish intrathecal meperidine as a potent anti-shivering strategy with a well-characterised safety profile, informing clinical guidelines for neuraxial anaesthesia protocols.

Postoperative Shivering Management in Anesthesia publication trend

The graph below shows the total number of articles in postoperative shivering management in anesthesia across all publications each year (not limited to Nature Index journals).

Technical terms

Thermoregulation: The physiological mechanisms that maintain core body temperature within a narrow range.

Intrathecal administration: Delivery of medication directly into the cerebrospinal fluid within the spinal canal.

Meperidine (Pethidine): An opioid analgesic with anti-shivering properties mediated by κ-opioid receptor activity and central thermoregulatory modulation.

Dexmedetomidine: A selective α2-adrenoceptor agonist that exerts sedative and anti-shivering effects by reducing sympathetic outflow and lowering the shivering threshold.

References

1. Preventing shivering with adjuvant low dose intrathecal meperidine: A meta-analysis of randomized controlled trials with trial sequential analysis. Scientific Reports (2017).
2. Comparative study between intrathecal dexmedetomidine and intrathecal magnesium sulfate for the prevention of post-spinal anaesthesia shivering in uroscopic surgery; (RCT). BMC Anesthesiology (2019).
3. Intravenous dexmedetomidine versus tramadol for treatment of shivering after spinal anesthesia: a meta-analysis of randomized controlled trials. BMC Anesthesiology (2020).
4. Effect of Prophylactic Intrathecal Pethidine on the Incidence of Shivering on Mothers Undergoing Cesarean Section Under Spinal Anesthesia: A Randomized Controlled Trial. Frontiers in Medicine (2022).