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
Processing time: 166 Days and 12 Hours
ARTICLE HIGHLIGHTS
Research background

Perioperative shivering is clinically common during caesarean section, and several neuraxial adjuvants have been used to prevent perioperative shivering. However, the effects of these neuraxial adjuvants and which one is preferred remain elusive.

Research motivation

To provide evidence for clinicians to choose the optimal neuraxial adjuvant to reduce perioperative shivering during cesarean section.

Research objectives

To evaluate the effects of different neuraxial adjuvants on perioperative shivering during cesarean section.

Research methods

A systematic review and network meta-analysis (NMA) were conducted following the PRISMA guidelines. We performed a comprehensive search of PubMed, EMBASE, Web of Science, and Cochrane Central databases for eligible clinical trials assessing the effects of neuraxial adjuvants on perioperative shivering. Analyses were performed using Review Manager 5.3 and Stata 14.0.

Research results

Pethidine, fentanyl, dexmedetomidine, and sufentanil are more efficacious than other medications in the prevention of shivering during caesarean sections. Among the above four adjuvants, pethidine was most effective for shivering prevention (OR = 0.15, 95%CI: 0.07-0.35, SUCRA 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), with a significantly decreased incidence of nausea (OR = 0.34, 95%CI: 0.15-0.79) and vomiting (OR = 0.25, 95%CI: 0.11-0.56). Furthermore, compared with sufentanil, fentanyl showed no impact on haemodynamic stability and the incidence of pruritus.

Research conclusions

The results of this NMA indicated that neuraxial pethidine, fentanyl, dexmedetomidine, sufentanil appear to be more efficacious than other medications in the prevention of shivering during caesarean section. Considering the risk-benefit profiles of the included neuraxial adjuvants, fentanyl is probably the optimal choice for the prevention of perioperative shivering during cesarean section. Although several neuraxial adjuvants have been reported to prevent shivering during caesarean section, very few clinical trials directly compared the neuraxial adjuvants during caesarean section. Thus, it is currently impossible to perform a pairwise meta-analysis to directly compare the difference between two neuraxial adjuvants. More clinical trials that directly compare these neuraxial adjuvants (e.g., neuraxial pethidine vs fentanyl) are needed to fully explore the possible differences between the effects of these adjuvants.