A Randomized, Double-Blind Clinical Trial Comparing Prophylactic Intravenous Paracetamol and Intravenous Meperidine for Shivering During Cesarean Delivery Under Spinal Anesthesia
| Author | Milad Masaeli | en |
| Author | Mohammad Reza Habibzadeh | en |
| Author | Setayesh Sindarreh | en |
| Author | Zahra Ghasemi | en |
| Author | Tayyebe Faraji | en |
| Orcid | Milad Masaeli [0000-0002-5620-0955] | en |
| Orcid | Mohammad Reza Habibzadeh [0000-0002-5094-7900] | en |
| Orcid | Setayesh Sindarreh [0000-0001-8481-9184] | en |
| Orcid | Zahra Ghasemi [0009-0000-3106-2560] | en |
| Issued Date | 2026-12-31 | en |
| Abstract | Background: Shivering is a distressing and common complication of spinal anesthesia for cesarean delivery (CD), with reported incidence rates of up to 55%. It increases maternal metabolic demand, thereby posing risks for patients with cardiopulmonary conditions. Although meperidine is an effective and well-established prophylactic agent, its use is limited by opioid-related adverse effects. Intravenous (IV) paracetamol is a non-opioid alternative that may reduce shivering by centrally modulating the thermoregulatory set point. Objectives: This randomized, double-blind clinical trial compared the prophylactic efficacy of intravenous paracetamol and intravenous meperidine in preventing shivering during CD under spinal anesthesia. Methods: In this randomized, double-blind clinical trial, 151 patients undergoing CD under spinal anesthesia were allocated to receive 1 g IV paracetamol (PARA), 0.3 mg/kg IV meperidine (MEP-IV), or normal saline (CTL) preoperatively. The primary outcomes were the incidence and intensity of shivering, assessed using a 4-point scale. Secondary outcomes included shivering onset time, hemodynamic stability (including mean arterial pressure [MAP] and heart rate [HR]), and adverse events. Longitudinal hemodynamic data were analyzed using repeated-measures analysis of variance. Results: The overall incidence of shivering did not differ significantly among the groups (P = 0.146), with rates of 49.0% in the PARA group, 33.3% in the MEP-IV group, and 49.0% in the CTL group. Although IV paracetamol did not significantly reduce the overall incidence of shivering compared with meperidine or placebo, it was associated with a delayed onset and lower shivering severity. Conclusions: Intravenous paracetamol may represent a potential non-opioid option for managing shivering during CD under spinal anesthesia. | en |
| DOI | https://doi.org/10.5812/ipmn-167539 | en |
| URI | https://brieflands.com/journals/ipmn/articles/167539 | en |
| Keyword | Shivering | en |
| Keyword | Cesarean Section | en |
| Keyword | Spinal Anesthesia | en |
| Keyword | Paracetamol | en |
| Keyword | Meperidine | en |
| Keyword | Obstetric Anesthesia | en |
| Publisher | Brieflands | en |
| Title | A Randomized, Double-Blind Clinical Trial Comparing Prophylactic Intravenous Paracetamol and Intravenous Meperidine for Shivering During Cesarean Delivery Under Spinal Anesthesia | en |
| Type | Research Article | en |
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