The Effect of Paracetamol Administration on Interleukin-6 Levels and the Incidence of Shivering in Cesarean Section Patients with Spinal Anesthesia

Afian Ishak  Prasetyo; Alamsyah Ambo  Ala Husain; Andi Muhammad  Takdir Musba; Syamsul Hilal  Salam; . Ratnawati; Charles  Wijaya Tan

doi:10.18502/aacc.v11i5.19917

Afian Ishak Prasetyo Department of Anaesthesia, Intensive Care and Pain Management, Hasanuddin University, Makassar, Indonesia.
Alamsyah Ambo Ala Husain Department of Anaesthesia, Intensive Care and Pain Management, Hasanuddin University, Makassar, Indonesia.
Andi Muhammad Takdir Musba Department of Anaesthesia, Intensive Care and Pain Management, Hasanuddin University, Makassar, Indonesia.
Syamsul Hilal Salam Department of Anaesthesia, Intensive Care and Pain Management, Hasanuddin University, Makassar, Indonesia.
. Ratnawati Department of Anaesthesia, Intensive Care and Pain Management, Hasanuddin University, Makassar, Indonesia.
Charles Wijaya Tan Department of Anaesthesia, Intensive Care and Pain Management, Hasanuddin University, Makassar, Indonesia.

DOI: https://doi.org/10.18502/aacc.v11i5.19917

Keywords: Paracetamol; Shivering; Interleukin-6; Cesarean section ; Spinal anesthesia

Abstract

Background: Cesarean section operation with spinal anesthesia is one of the most frequently performed surgical operations worldwide. Perioperative shivering is a problem that often happens during surgery with spinal anesthesia, with an incidence that can be up to 50%. Nevertheless, this shivering condition still receives less attention in the literature and daily clinical practice. Paracetamol lowers hypothalamic temperature set points to reduce postoperative shivering by centrally inhibiting prostaglandins. By lowering thermoregulatory set points and IL-6 levels, paracetamol has also been demonstrated to lessen postoperative stress.

Methods: This study was designed as a double-blind, randomized, controlled trial involving 34 participants randomly distributed between two groups. Group 1 (n=17) will receive paracetamol 15 mg/kg body weight, and group 2 (n=17) will receive 100 mL of 0.9% sodium chloride solution. Shivering is assessed using the Bedside Shivering Assessment Score at 0, 15, 30, 45, 60, and 120 minutes after injecting the drug into the subarachnoid space. Interleukin-6 (IL-6) levels will be taken by taking peripheral blood samples 3 times (1 hour before surgery, 1 hour after surgery, and 6 hours after surgery) and then examined using the Enzyme-Linked Immunosorbent Assay (ELISA) method in pg/dL.

Results: The statistical analysis showed no significant difference (P>0.05) in the IL-6 comparison between the paracetamol and control groups. However, compared with the control group, the paracetamol group's average IL-6 levels were lower. Statistical analysis revealed a significant difference (P = 0.038) in the incidence between those receiving paracetamol and those in control groups. The paracetamol group demonstrated a lower incidence of shivering (35.3%) than the control group (76.5%). Significant variations (P = 0.038) were also observed in the onset of shivering between the paracetamol and the control group. The paracetamol group experienced shivering at a later time (between minutes 45 and 120) than the control group (between minutes 30 and 60).

Conclusion: Administration of 15 mg/kg BW paracetamol significantly reduced shivering incidents, shivering onset, and the need for rescue pethidine compared to the control group that received 100 ml of 0.9% sodium chloride after a cesarean section with spinal anesthesia but did not significantly reduce IL-6 levels.