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Comparative effectiveness of pharmacologic interventions to prevent shivering after surgery: a network meta-analysis.

Abstract：

INTRODUCTION:Although many drugs have been studied to prevent postoperative shivering, their comparative effectiveness is unknown. We attempted to assess the comparative effectiveness of the pharmacologic strategies to prevent shivering after surgery including intravenous (IV) and intrathecal (IT) meperidine, IV and IT dexmedetomidine, IV and IT clonidine, nefopam, tramadol, ketamine, and serotonin receptor antagonists. EVIDENCE ACQUISITION:We implemented a frequentist network meta-analysis of randomized trials. Random effect model was selected according to deviance information criteria. The incidence of moderate or severe shivering and the overall incidence of postoperative shivering were compared in all patients and subgroups of general and spinal anesthesia. EVIDENCE SYNTHESIS:Seventy trials with 6062 participants were included. All interventions except clonidine IT and dexmedetomidine IT significantly decreased the incidence of moderate or severe shivering. All interventions except clonidine IT significantly decreased the overall incidence of shivering. Nefopam IV was ranked best regarding both the incidence of moderate or severe shivering (odds ratio [OR] 0.04, 95% confidence interval [CI] 0.04-0.25, SUCRA 86.2, moderate quality-evidence), and the overall incidence of shivering (OR 0.07, 95% CI 0.03 to 0.15, SUCRA 85.7, moderate quality-evidence), which was consistent in the subgroups of anesthesia. CONCLUSIONS:Nefopam was ranked best regarding both severity and incidence of postoperative shivering. In addition to nefopam, tramadol, meperidine IV and IT, and dexmedetomidine IV were ranked high. However, there was significant heterogeneity regarding the individual drug regimen and surgery type, precluding firm conclusion. Further randomized trials are required to compare the efficacy of the drugs with high rank.

journal_name

Minerva Anestesiol

journal_title

Minerva anestesiologica

authors

Kang P,Park SK,Yoo S,Hur M,Kim WH,Kim JT,Bahk JH

doi

10.23736/S0375-9393.18.12813-6

subject

Has Abstract

pub_date

2019-01-01 00:00:00

pages

60-70

issue

1

eissn

0375-9393

issn

1827-1596

pii

S0375-9393.18.12813-6

journal_volume

85

pub_type

杂志文章,meta分析,评审

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