Comparative efficacy of intravenous treatments for perioperative shivering in patients undergoing caesarean delivery under neuraxial anaesthesia: A systematic review and Bayesian network meta-analysis of randomised-controlled trials

IF 5 2区医学 Q1 ANESTHESIOLOGY

Journal of Clinical Anesthesia Pub Date : 2024-11-27 DOI:10.1016/j.jclinane.2024.111680

Guillermina Ferrea , David T. Monks , Preet Mohinder Singh , Kelly Fedoruk , Narinder Pal Singh , Lindsay Blake , Brendan Carvalho , Pervez Sultan

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引用次数: 0

Abstract

Introduction

Shivering affects 52 % of patients undergoing caesarean delivery under neuraxial anaesthesia. Despite extensive research focused on its prevention, there is still no consensus regarding optimal pharmacological treatment. This systematic review and network meta-analysis aims to compare available intravenous treatments of perioperative shivering in patients undergoing caesarean delivery under neuraxial anaesthesia.

Methods

We searched seven databases (PubMed MEDLINE, Scopus, Web of Science, Embase, LILACS, Cochrane CRCT and clinicaltrials.gov) for randomised controlled trials comparing intravenous treatments of perioperative shivering during caesarean delivery and performed a Bayesian model network meta-analysis. We assessed study quality using the Cochrane risk of bias assessment tool. The primary outcome evaluated in this meta-analysis was shivering control (cessation or significant reduction in intensity), and secondary outcomes included time to shivering control, shivering recurrence, and incidence of maternal nausea.

Results

Twenty randomised controlled trials, with a total of 1983 patients, were included in this analysis. Network estimates of odds ratios (OR [95 % Credible Interval]) of effective treatment of shivering compared with saline were: dexmedetomidine (38.1 [14.2 to 111.5]), tramadol (33.6 [15.1 to 81.8]), nalbuphine (26.2 [10.8 to 80.2]), meperidine (20.9 [6.2 to 73.1]), ondansetron (6.6 [2.2 to 23.2]), and clonidine (3.2 [0.6 to 14.9]). The rank order of interventions by surface area under the cumulative ranking curve scores (in parenthesis) for shivering control was dexmedetomidine (0.87) > tramadol (0.85) > nalbuphine (0.74) > meperidine (0.66) > ondansetron (0.41) > clonidine (0.3) > amitriptyline (0.03). Dexmedetomidine was also the top-ranked intervention for time to shivering control, shivering recurrence and maternal nausea. We judged the certainty in the evidence to be moderate for dexmedetomidine and nalbuphine, and low for all other interventions.

Conclusion

This network meta-analysis identified four effective intravenous treatments for shivering in patients undergoing caesarean delivery under neuraxial anaesthesia: dexmedetomidine, tramadol, nalbuphine and meperidine. Dexmedetomidine was the top-ranked intervention for all outcomes.

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神经麻醉下剖腹产患者围术期颤抖的静脉治疗效果比较：随机对照试验的系统回顾和贝叶斯网络荟萃分析

导言52% 接受神经麻醉的剖腹产患者都会出现颤抖。尽管对其预防进行了广泛研究，但对于最佳药物治疗仍未达成共识。本系统综述和网络荟萃分析旨在比较现有的针对神经麻醉下剖腹产患者围手术期颤抖的静脉治疗方法。方法我们在七个数据库（PubMed MEDLINE、Scopus、Web of Science、Embase、LILACS、Cochrane CRCT 和 clinicaltrials.gov）中搜索了比较剖腹产围手术期颤抖静脉治疗方法的随机对照试验，并进行了贝叶斯模型网络荟萃分析。我们使用 Cochrane 偏倚风险评估工具对研究质量进行了评估。本荟萃分析评估的主要结果是颤抖控制（停止或强度显著降低），次要结果包括颤抖控制时间、颤抖复发率和产妇恶心发生率。5]）、曲马多（33.6 [15.1 至 81.8]）、纳布啡（26.2 [10.8 至 80.2]）、美培林（20.9 [6.2 至 73.1]）、昂丹司琼（6.6 [2.2 至 23.2]）和氯尼丁（3.2 [0.6 至 14.9]）。按累积排名曲线下表面积得分（括号内）计算，控制颤抖的干预措施排名依次为右美托咪定（0.87）、曲马多（0.85）、纳鲁布啡（0.74）、美培林（0.66）、昂丹司琼（0.41）、氯尼丁（0.3）、阿米替林（0.03）。右美托咪定也是在颤抖控制时间、颤抖复发和产妇恶心方面排名第一的干预措施。我们认为右美托咪定和纳布啡的证据确定性为中度，而所有其他干预措施的证据确定性为低度。结论这项网络荟萃分析确定了四种有效的静脉治疗方法，用于治疗神经麻醉下剖宫产患者的颤抖：右美托咪定、曲马多、纳布啡和甲哌啶。就所有结果而言，右美托咪定是排名第一的干预方法。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Clinical Anesthesia 医学-麻醉学

CiteScore

7.40

自引率

4.50%

发文量

346

审稿时长

23 days

期刊介绍： The Journal of Clinical Anesthesia (JCA) addresses all aspects of anesthesia practice, including anesthetic administration, pharmacokinetics, preoperative and postoperative considerations, coexisting disease and other complicating factors, cost issues, and similar concerns anesthesiologists contend with daily. Exceptionally high standards of presentation and accuracy are maintained. The core of the journal is original contributions on subjects relevant to clinical practice, and rigorously peer-reviewed. Highly respected international experts have joined together to form the Editorial Board, sharing their years of experience and clinical expertise. Specialized section editors cover the various subspecialties within the field. To keep your practical clinical skills current, the journal bridges the gap between the laboratory and the clinical practice of anesthesiology and critical care to clarify how new insights can improve daily practice.