Meta-Analysis
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Aug 26, 2019; 7(16): 2287-2301
Published online Aug 26, 2019. doi: 10.12998/wjcc.v7.i16.2287
Neuraxial adjuvants for prevention of perioperative shivering during cesarean section: A network meta-analysis following the PRISMA guidelines
Yi-Wei Zhang, Juan Zhang, Jia-Qi Hu, Chun-Lei Wen, Shu-Yang Dai, Dan-Feng Yang, Li-Fang Li, Qi-Biao Wu
Yi-Wei Zhang, Qi-Biao Wu, State Key Laboratory of Quality Research in Chinese Medicines, Macau University of Science and Technology, Macau 999078, China
Yi-Wei Zhang, Li-Fang Li, Qi-Biao Wu, Faculty of Chinese Medicine, Macau University of Science and Technology, Macau 999078, China
Juan Zhang, Jia-Qi Hu, Chun-Lei Wen, Department of Anesthesiology, First Affiliated Hospital, Zhejiang Chinese Medical University, Hangzhou 310000, Zhejiang Province, China
Jia-Qi Hu, Department of Pain, Zhejiang Provincial People's Hospital, Hangzhou 310000, Zhejiang Province, China
Shu-Yang Dai, Department of Anesthesiology, Ruian People's Hospital, Wenzhou Medical University, Wenzhou 325000, Zhejiang Province, China
Dan-Feng Yang, Department of Anesthesiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310000, Zhejiang Province, China
Author contributions: All authors contributed to the manuscript.
Supported by The Science and Technology Development Fund, Macau SAR, No. 130/2017/A3 and No. 0099/2018/A3.
Conflict-of-interest statement: The authors deny any conflict of interest.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Qi-Biao Wu, MD, Associate Professor, Doctor, State Key Laboratory of Quality Research in Chinese Medicines, Macau University of Science and Technology, Avenida Wai Long, Macau 999078, China. qbwu@must.edu.mo
Telephone: +86-853-88972792
Received: March 14, 2019
Peer-review started: March 15, 2019
First decision: June 19, 2019
Revised: June 25, 2019
Accepted: July 20, 2019
Article in press: July 20, 2019
Published online: August 26, 2019
Abstract
BACKGROUND

Perioperative shivering is clinically common during cesarean sections under neuraxial anesthesia, and several neuraxial adjuvants are reported to have preventive effects on it. However, the results of current studies are controversial and the effects of these neuraxial adjuvants remain unclear.

AIM

To evaluate the effects of neuraxial adjuvants on perioperative shivering during cesarean sections, thus providing an optimal choice for clinical application.

METHODS

A systematic review and network meta-analysis were conducted following the PRISMA (Preferred Reported Items for Systematic Review and Meta-analysis) guidelines. Analyses were performed using Review Manager 5.3 and Stata 14.0. We searched PubMed, EMBASE, Web of Science, and Cochrane Central databases for eligible clinical trials assessing the effects of neuraxial adjuvants on perioperative shivering and other adverse events during cesarean sections. Perioperative shivering was defined as the primary endpoint, and nausea, vomiting, pruritus, hypotension, and bradycardia were the secondary outcomes.

RESULTS

Twenty-six studies using 9 neuraxial adjuvants for obstetric anesthesia during caesarean sections were included. The results showed that, compared with placebo, pethidine, fentanyl, dexmedetomidine, and sufentanil significantly reduced the incidence of perioperative shivering. Among the four neuraxial adjuvants, pethidine was the most effective one for shivering prevention (OR = 0.15, 95%CI: 0.07-0.35, surface under the cumulative ranking curve 83.9), but with a high incidence of nausea (OR = 3.15, 95%CI: 1.04-9.57) and vomiting (OR = 3.71, 95%CI: 1.81-7.58). The efficacy of fentanyl for shivering prevention was slightly inferior to pethidine (OR = 0.20, 95%CI: 0.09-0.43), however, it significantly decreased the incidence of nausea (OR = 0.34, 95%CI: 0.15-0.79) and vomiting (OR = 0.25, 95%CI: 0.11-0.56). In addition, compared with sufentanil, fentanyl showed no impact on haemodynamic stability and the incidence of pruritus.

CONCLUSION

Pethidine, fentanyl, dexmedetomidine, and sufentanil appear to be effective for preventing perioperative shivering in puerperae undergoing cesarean sections. Considering the risk-benefit profiles of the included neuraxial adjuvants, fentanyl is probably the optimal choice.

Keywords: Neuraxial adjuvants, Shivering, Cesarean section, Prevention, Network meta-analysis

Core tip: Shivering is a common complication of obstetric anaesthesia, especially during caesarean section. Recently, several neuraxial adjuvants have been used for the prevention of shivering. However, the results of current studies are controversial and the role of these adjuvants in obstetric anesthesia remains unclear. The aim of our network meta-analysis is to evaluate the effects of neuraxial adjuvants on shivering and other side effects, thus providing an optimal choice for clinical application.