From the Research
Excessive shaking after a cesarean section is typically a normal physiological response called postoperative shivering or rigors, which affects up to 60% of women following a c-section. This shaking is usually caused by several factors including the body's response to anesthesia (particularly spinal or epidural), rapid temperature changes during surgery, exposure in the operating room, fluid shifts, or the release of inflammatory mediators during surgery 1.
Causes and Risk Factors
The causes of postoperative shivering can be multifactorial, and some studies suggest that anxiety levels and the number of previous deliveries may also play a role in the incidence of shivering during cesarean section under spinal anesthesia 2.
- The incidence of shivering can be decreased by the addition of certain medications to the spinal anesthesia, such as sufentanil 3.
- Other factors such as age, weight, height, BMI, and American Society of Anesthesiologists score may not be significant predictors of shivering 2.
Treatment and Management
The shaking is generally self-limiting and resolves within 20-30 minutes.
- Treatment options include warming blankets, warm IV fluids, and medications such as meperidine (Demerol) 25mg IV or clonidine 0.1mg orally if the shaking is severe or prolonged 1.
- Other medications such as intrathecal dexmedetomidine, intrathecal fentanyl, intrathecal sufentanil, intrathecal meperidine, intravenous ketamine, and intravenous tramadol may also be effective in reducing shivering during cesarean sections under neuraxial anesthesia 1.
Complications and Concerns
While usually benign, persistent shaking accompanied by fever could indicate an infection, and severe shaking with other symptoms like chest pain or difficulty breathing might suggest more serious complications such as pulmonary embolism or amniotic fluid embolism.
- Patients should inform their healthcare provider if the shaking is severe, prolonged beyond 30 minutes, or accompanied by other concerning symptoms.