Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea.
Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea -
Minerva Anestesiol. 2019 Jan;85(1):60-70. doi: 10.23736/S0375-9393.18.12813-6. Epub 2018 Sep 18.
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.
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.
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.
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.
尽管已经研究了许多药物来预防术后寒战，但它们的相对有效性尚不清楚。我们试图评估预防手术后寒战的药物策略的相对有效性，包括静脉（IV）和鞘内（IT）哌替啶、IV 和 IT 右美托咪定、IV 和 IT 可乐定、奈福泮、曲马多、氯胺酮和 5-羟色胺受体拮抗剂。
我们对随机试验进行了频率网络荟萃分析。根据偏差信息标准选择随机效应模型。在所有患者和全身麻醉和脊髓麻醉亚组中比较了中度或重度寒战的发生率和术后寒战的总发生率。
纳入了 70 项试验，共 6062 名参与者。除可乐定 IT 和右美托咪定 IT 外，所有干预措施均显著降低了中度或重度寒战的发生率。除可乐定 IT 外，所有干预措施均显著降低了寒战的总发生率。奈福泮 IV 在中度或重度寒战的发生率（比值比 [OR] 0.04，95%置信区间 [CI] 0.04-0.25，SUCRA 86.2，中等质量证据）和寒战总发生率（OR 0.07，95% CI 0.03 至 0.15，SUCRA 85.7，中等质量证据）方面的排名均最佳，在麻醉亚组中也一致。
奈福泮在术后寒战的严重程度和发生率方面排名最佳。除奈福泮外，曲马多、IV 和 IT 哌替啶和 IV 右美托咪定的排名也较高。然而，由于个别药物方案和手术类型存在显著异质性，因此无法得出确定的结论。需要进一步的随机试验来比较高排名药物的疗效。
