Shivers after epidurals

ldnurse7581 · Jun 7, 2006

when the crna gives the test dose, we hit the "stat" bp button that takes bp's like right after each other for like approx 5min then q15min. (and we take vitals q15m while in labor,even before epidural). as far as the shaking, we always say that the shaking and itching is just a s/e of epidural. i dont think i have had a pt ask exactly what it was that caused the shaking..

Haunted · Jun 7, 2006

In the OR and post op we treat it with 12.5-25 mg of demerol IVP. How do you treat it in L and D ?

LuvMyGamecocks · Jun 7, 2006

I've often wondered about why it is that epidurals can cause shaking and itching. When I was being prepped to deliver my firstborn by emergency c/s, I began shaking so badly that I was unable to speak.

Is there an actual medical explanation or just noted as a side effect?

MeMaRN · Jun 8, 2006

We do not have any standing orders like Demerol IVP after an epidural is in. I know it's used in the recovery room for shivering but not in our L&D unit. I just feel bad for these Mom's who look so forward to pain relief only to be miserable with the shivers. I also don't understand why it seems to affect some moms more than others.

chadash · Jun 8, 2006

I shivered like crazy during a c-section. They told me that some how neurologically the brain was getting the "I am very cold" message. Actually, warming seemed to help a bit, or maybe it just wore off.

Woman_in_love · Jun 9, 2006

I dont really think it has to do with epidural only.

I've had a patient after regular delivery without any anesthesia and she was shivering a lot. I think it has to do with drastic hormone level changes after delivery. Thats pretty common, they even mention it in books.

Also i had another patient to undergo her C-section and she was shivering quite a lot. Possibly the OR was too cold(they always are kinda very cool) or just nerves.

L&Dnurse2Be · Jun 9, 2006

I was told that the deramorph (sp) after the c-section/epidural caused the itchting/shaking. Maybe I'm wrong.

htrn · Jun 12, 2006

Shaking can be adreanaline from the normal labor process, cold from all the IVF we dump into them so quickly or hormones. The itching we see is a side effect when they use fentynal in the epidurals. Morphine can cause itching too. Our docs tell pts that most pts would rather put up with the shaking and the itching than labor.

MA Nurse · Jun 12, 2006

MeMaRN said:
How do you explain the shivers to your patients after an epidural? I've heard explanations ranging from the mother's hormones, to blood pressure issues. (All of the explanations given by anest.)
Also, how many blood pressure readings are you required to chart at your facilities following the epidural. Our facility's policy is q 5 minutes x 15 minutes, then q 15 minutes.

I had shivering after my first daughter, but not after the 2nd and 3rd (with epidurals). I thought it was the transition from being in labor to giving birth...like a shock to your system or something. I don't think all women get the shivers, do they?

kids · Jun 12, 2006

Haunted said:
In the OR and post op we treat it with 12.5-25 mg of demerol IVP. How do you treat it in L and D ?

Pre/intra/post op has never been my thing, but I had never heard of Demerol for shivering until I received it in recovery following surgery a few months go. For me it was definitely a neurological phenomenon, I was awake, fairly lucid and warm when uncontrollable teeth chattering shivers hit.

kenwishaw · Feb 7, 2012

In most cases shivering after epidurals is caused by redistribution hypothermia. The epidural dramatically increases blood flow to the legs and if the legs are even a few degrees cooler then the core the blood will return cooled and cause a drop in core temperature. This cannot be detected with a thermometer prior to the epidural but can be detected by putting your hand on the patients calf muscle. The incidence of shivering is dramatically decreased by prewarming the legs prior to the epidural. A small percentage of patients will shiver in spite of this and Pethidine (demerol) 12.5 mg may help.

Ken, anaesthesiologist.