Neuraxial adjuvants for prevention of perioperative shivering during cesarean section: A network meta-analysis following the PRISMA guidelines  

作　　者：Yi-Wei Zhang Juan Zhang Jia-Qi Hu Chun-Lei Wen Shu-Yang Dai Dan-Feng Yang Li-Fang Li Qi-Biao Wu 

机构地区：[1]State Key Laboratory of Quality Research in Chinese Medicines,Macao University of Science and Technology,Macao 999078,China [2]Faculty of Chinese Medicine,Macao University of Science and Technology,Macao 999078,China [3]Department of Anesthesiology,First Affiliated Hospital,Zhejiang Chinese Medical University,Hangzhou 310000,Zhejiang Province,China [4]Department of Pain,Zhejiang Provincial People's Hospital,Hangzhou 310000,Zhejiang Province,China [5]Department of Anesthesiology,Ruian People's Hospital,Wenzhou Medical University,Wenzhou 325000,Zhejiang Province,China [6]Department of Anesthesiology,Sir Run Run Shaw Hospital,Zhejiang University School of Medicine,Hangzhou 310000,Zhejiang Province,China

出　　处：《World Journal of Clinical Cases》2019年第16期2287-2301,共15页世界临床病例杂志

基　　金：Supported by The Science and Technology Development Fund,Macao SAR,No.130/2017/A3 and No.0099/2018/A3

摘　　要：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 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, dexme

关 键 词：Neuraxial ADJUVANTS SHIVERING CESAREAN section PREVENTION Network metaanalysis 

分 类 号：R[医药卫生]