Neuraxial Morphine-Induced Hypothermia After Cesarean Delivery Managed With Nalbuphine: A Case Report

Atypical Clinical Presentation of Hypothermia Induced by Intrathecal Morphine in a Patient Who Underwent Total Knee Arthroplasty Under Spinal Anesthesia: A Case Report

This case report describes a 62-year-old male who experienced paradoxical hypothermia following an elective total knee replacement (TKR) performed under spinal anesthesia with intrathecal morphine administration. The patient presented with significant hypothermia, defined as a body temperature below 35°C, approximately 45 minutes following the administration of anesthesia. The condition demonstrated resistance to conventional rewarming techniques. This condition required symptomatic treatment, leading to the administration of naloxone. After receiving two doses of naloxone, the patient's temperature stabilized, and they experienced a reduction in diaphoresis, improved alertness, and less nausea. Given the scarce documentation on non-obstetric paradoxical hypothermic reactions to intrathecal morphine, this case highlights the critical need for careful temperature monitoring when administering spinal anesthesia with intrathecal opioids. Additionally, it highlights the unusual symptoms of hypothermia that can hinder diagnosis and treatment, stressing the need for increased awareness among anesthesiologists to achieve the best possible patient outcomes.

Hypothermia With Paradoxical Symptoms: A Case Series of Cesarean Deliveries With Intrathecal Morphine

Women receiving intrathecal morphine for cesarean delivery may experience hypothermia with paradoxical symptoms of sweating, nausea, and shivering. Despite being relatively rare in comparison to commonly experienced symptoms of perioperative hypothermia, hypothermia with paradoxical symptoms affects early maternal recovery and comfort. The cause is undetermined, and treatment approaches vary. Regular active-warming strategies may not be tolerated because of the paradoxical symptoms of sweating and feeling overheated. This case series aims to explore the phenomenon through the evaluation of health care records of women receiving intrathecal morphine for cesarean delivery at a single, tertiary health care institution in Australia from 2015 to 2018. We also summarize published literature to review treatment approaches used in the care of women experiencing profound heat loss while feeling overheated.

Comparison of the analgesic effects of two quadratus lumborum blocks (QLBs), QLB type II vs QLB type III, in caesarean delivery: A randomised study

BACKGROUND

Quadratus lumborum blocks (QLBs) are relatively novel regional anaesthesia techniques, and the efficacy of all three types of QLB for postoperative analgesia in caesarean delivery (CD) has been demonstrated in separate studies. The aim of the present study is to compare the analgesic efficacy of the QLB-II and QLB-III blocks performed at the end of surgery in patients undergoing spinal anaesthesia for CD.

METHODS

We conducted a comparative, blinded, prospective, randomised and efficiency study. A total of 80 patients scheduled for elective CD under spinal anaesthesia were randomly allocated to receive either bilateral ultrasound-guided QLB-II or QLB-III block in a 1:1 ratio. The primary outcome was opioid consumption administered by a patient-controlled analgesia in the first 24 hours postoperatively. The secondary outcome of the study was pain intensity. Also, the time of first opioid requirement and the presence of nausea and vomiting were recorded.

RESULTS

Morphine consumption was statistically significantly lower in the QLB-III group when compared with the QLB-II group at the 3rd, 6th, 12th and 24th hours (P < .001, P < .001, P = .004, and P = .015, respectively). The QLB-III group showed significantly lower pain scores at rest at the 1st, 3rd, 6th, 9th and 24th hours after surgery (P < .001, P < .001, P < .001, P = .007 and P < .001, respectively). The QLB-III group also showed significantly lower pain score on movement at all measurement times (P < .001).

CONCLUSIONS

The analgesic efficacy of QLB-III was superior to QLB-II in patients who had undergone CD under spinal anaesthesia without use of intrathecal opioids and nonsteroidal anti-inflammatory drugs.