What does excessive shaking over an hour after spinal anesthesia for a C-section with Exparel (bupivacaine) indicate?

From the Guidelines

Excessive shaking over an hour after spinal anesthesia for a C-section with Exparel (bupivacaine) likely indicates shivering related to thermoregulatory disruption or a reaction to the anesthetic, which requires prompt evaluation and intervention to prevent complications. This condition can be caused by several factors, including:

• Thermoregulatory disruption due to spinal anesthesia, which can lead to hypothermia, as seen in 50-80% of patients undergoing spinal anesthesia 1
• Reaction to the anesthetic, such as bupivacaine
• Infection with fever
• High spinal anesthesia affecting respiratory muscles Management of excessive shaking typically involves:
• Warming measures, such as warm blankets or forced-air warming devices
• Medications like meperidine (25mg IV) or clonidine (0.075mg IV) to control severe shivering It is essential to monitor vital signs, especially temperature, blood pressure, and oxygen saturation, to promptly identify any potential complications. If shivering persists or is accompanied by other concerning symptoms, such as difficulty breathing, altered consciousness, or high fever, immediate medical attention is necessary to prevent serious complications.

From the Research

Excessive Shaking after Spinal Anesthesia for C-Section with Exparel

Excessive shaking over an hour after spinal anesthesia for a C-section with Exparel (bupivacaine) can be indicative of several factors. The following points summarize the possible causes and related studies:

• Hypothermia: Excessive shaking or shivering can be a response to hypothermia, which is a common complication after spinal anesthesia 2. The study suggests that hypothermia can occur due to the disruption of thermoregulation caused by the spinal anesthesia.
• Anxiety: Anxiety levels have been found to be a significant predictor of shivering during C-section under spinal anesthesia 3. The study found that higher anxiety levels increased the risk of shivering.
• Intrathecal medication: The use of intrathecal medications such as morphine and sufentanil can affect the incidence of shivering 4. The study found that the addition of sufentanil to hyperbaric bupivacaine and morphine decreased the incidence of shivering.
• Physiological response: Shivering can be a physiological response to the stress of surgery and anesthesia 5. The study discusses the common complications of spinal anesthesia, including hypotension and postdural puncture headache.

Some key findings related to excessive shaking after spinal anesthesia for C-section with Exparel include:

• The incidence of shivering after C-section under spinal anesthesia can be as high as 21.9% 3.
• The use of intrathecal sufentanil can decrease the incidence of shivering 4.
• Anxiety levels and the number of previous deliveries can be significant predictors of shivering 3.
• Hypothermia can occur due to the disruption of thermoregulation caused by spinal anesthesia 2.

Possible causes of excessive shaking after spinal anesthesia for C-section with Exparel include:

• Hypothermia
• Anxiety
• Intrathecal medication
• Physiological response to surgery and anesthesia

It is essential to note that these findings are based on studies and may not be directly applicable to every individual case. The exact cause of excessive shaking after spinal anesthesia for C-section with Exparel can only be determined by a medical professional after evaluating the individual's specific situation.