ORIGINAL ARTICLE| Volume 14, ISSUE 4, P279-283, October 2005

Hypothermia after cesarean delivery and its reversal with lorazepam


      Intrathecal morphine can produce hypothermia in animals. This side effect has been reported in humans, but has not been thoroughly studied in obstetrics.


      We report a series of 14 patients with presumed morphine-induced hypothermia. All patients had post-cesarean temperatures <35.8°C, and complained of associated symptoms of diaphoresis and subjective feeling of being hot. After collecting this series, we determined the incidence of this side effect in an observational study of 100 consecutive patients. All patients had spinal anesthesia with bupivacaine, morphine and fentanyl.


      In the case series, four of 14 patients were treated conservatively, and 10 were given lorazepam. Those treated conservatively had 6h of hypothermia and symptoms; women given lorazepam had a cessation of symptoms and a rapid increase in temperature. In the observational study, 6% (95% Confidence Interval: 1–10%) experienced symptomatic hypothermia lasting for several hours after the end of surgery (120–360 min). We found no statistical association with any demographic or obstetric characteristic.


      We conclude that symptomatic hypothermia is an occasional side effect of cesarean section under spinal anesthesia. We believe this syndrome is due to intrathecal morphine. While the duration is limited to 6h, lorazepam appears to treat both hypothermia and symptoms.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to International Journal of Obstetric Anesthesia
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Rio-Garcia J.
        • Cremades A.
        GABAergic mechanisms in morphine-induced hypothermia.
        Eur J Pharmacol. 1990; 187: 495-500
        • Rezvani A.H.
        • Gordon C.J.
        • Heath J.E.
        Action of preoptic injections of beta-endorphin on temperature regulation in rabbits.
        Am J Physiol. 1982; 243: R104-R111
        • Spencer R.L.
        • Hruby V.J.
        • Burks T.F.
        Alteration of thermoregulatory set point with opioid agonists.
        J Pharmacol Exp Ther. 1990; 252: 696-705
        • Chen X.
        • McClatchy D.B.
        • Geller E.B.
        • Liu-Chen L.
        • Tallarida R.J.
        • Adler M.W.
        Possible mechanism of hypothermia induced by intracerebroventricular injection of orphanin FQ/nociceptin.
        Brain Res. 2001; 904: 252-258
        • Clark W.G.
        Influence of opioids on central thermoregulatory mechanisms.
        Pharmacol Biochem Behav. 1979; 10: 609-613
        • Su C.F.
        • Liu M.Y.
        • Lin M.T.
        Intraventricular morphine produces pain relief, hypothermia, hyperglycaemia and increased prolactin and growth hormone levels in patients with cancer pain.
        J Neurol. 1987; 235: 105-108
        • Wishaw K.
        Hypothermia associated with subarachnoid morphine.
        Anaesth Intensive Care. 1997; 25: 586
        • Sayyid S.S.
        • Jabbour D.G.
        • Baraka A.S.
        Hypothermia and excessive sweating following intrathecal morphine in a parturient undergoing cesarean delivery.
        Reg Anesth Pain Med. 2003; 28: 140-143
        • Kavee E.H.
        • Bernstein J.
        • Zakowski M.I.
        • Ramanathan S.
        The hypothermic action of epidural and subarachnoid morphine in parturients.
        Reg Anesth. 1991; 16: 325-328
        • Ozaki M.
        • Kurz A.
        • Sessler D.I.
        • et al.
        Thermoregulatory thresholds during epidural and spinal anesthesia.
        Anesthesiology. 1994; 81: 282-288
        • Kurz A.
        • Sessler D.I.
        • Schroeder M.
        • Kurz M.
        Thermoregulatory response thresholds during spinal anesthesia.
        Anesth Analg. 1993; 77: 721-726
        • Frank S.M.
        • El Rahmany H.K.
        • Cattaneo C.G.
        • Barnes R.A.
        Predictors of hypothermia during spinal anesthesia.
        Anesthesiology. 2000; 92: 1330-1334
        • Horn E.P.
        • Schroeder F.
        • Gottschalk A.
        • et al.
        Active warming during cesarean delivery.
        Anesth Analg. 2002; 94: 409-414
        • Clark S.M.
        • Murphy M.T.
        • Lipton J.M.
        • Clark W.G.
        Effects of morphine on body temperature of squirrel monkeys of various ages.
        Brain Res Bull. 1983; 10: 305-308
        • Glyn-Ballinger J.R.
        • Clark W.G.
        • Lipton J.M.
        Altered body temperature of rabbits after central injection of beta-endorphin and other peptides.
        Brain Res. 1985; 333: 366-836
        • Clark W.G.
        • Clark Y.L.
        Changes in body temperature after administration of acetylcholine, histamine, morphine, prostaglandins and related agents.
        Neurosci Biobehav Rev. 1980; 4: 175-240
        • Cavicchini E.
        • Candeletti S.
        • Spampinato S.
        • Ferri S.
        Hypothermia elicited by some prodynorphin-derived peptides: opioid and non-opioid actions.
        Neuropeptides. 1989; 14: 45-50
        • Ikeda T.
        • Kurz A.
        • Sessler D.I.
        • et al.
        The effect of opioids on thermoregulatory responses in humans and the special antishivering action of meperidine.
        Ann NY Acad Sci. 1997; 813: 792-798