How postoperative shivering is affected by time of paracetamol administration during surgery?

Recently published study compared the incidence of postoperative shivering in patients receiving intravenous paracetamol (PCM) at different times. Postoperative shivering can result from an increased core body temperature set point, and IV PCM has been shown to reduce this by inhibiting prostaglandins to decrease the hypothalamic temperature set point. The trial involved 225 ASA I/II adult patients undergoing elective surgeries under general anesthesia (GA), where the patients were grouped to receive PCM immediately after anesthesia induction, 30 minutes before completion of surgery, or no PCM. The study found that administering PCM 30 minutes before completion of surgery resulted in the lowest incidence of postoperative shivering and hypothermia, as well as a longer time to analgesic requirement, compared to PCM administration after anesthesia induction or no PCM. The study also discussed the mechanism of PCM in preventing shivering and reducing post-surgical stress. Furthermore, the researchers highlighted that the peak hypothermic action of PCM is about 120 minutes. The study concluded that administering PCM close to the end of surgery maximizes its benefits in preventing shivering and providing good postoperative analgesia. The results also supported the practice of administering PCM as part of multimodal analgesia during surgery. However, the study had limitations related to the duration of procedures and ambient operating room temperatures.

Reference-

Mohta, Medha; Mounika, T. Bindu; Tyagi, Asha. Effect of timing of intraoperative administration of paracetamol on postoperative shivering: A randomised double-blind controlled trial. Indian Journal of Anaesthesia 67(12):p 1071-1076, December 2023. | DOI: 10.4103/ija.ija_720_23