Ferrea Guillermina, Monks David T, Singh Preet Mohinder, Fedoruk Kelly, Singh Narinder Pal, Blake Lindsay, Carvalho Brendan, Sultan Pervez
Department of Anesthesia and Perioperative Medicine, Division of Surgery and Interventional Science, University College London, London, UK.
Department of Anesthesiology, Washington University in Saint Louis, St Louis, MO, USA.
J Clin Anesth. 2025 Jan;100:111680. doi: 10.1016/j.jclinane.2024.111680. Epub 2024 Nov 27.
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.
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.
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.
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.
寒颤影响52%接受椎管内麻醉下剖宫产的患者。尽管针对其预防进行了广泛研究，但关于最佳药物治疗仍未达成共识。本系统评价和网状Meta分析旨在比较椎管内麻醉下剖宫产患者围手术期寒颤的现有静脉治疗方法。
我们检索了七个数据库（PubMed MEDLINE、Scopus、Web of Science、Embase、LILACS、Cochrane CRCT和clinicaltrials.gov），以查找比较剖宫产期间围手术期寒颤静脉治疗方法的随机对照试验，并进行了贝叶斯模型网状Meta分析。我们使用Cochrane偏倚风险评估工具评估研究质量。本Meta分析评估的主要结局是寒颤控制（停止或强度显著降低），次要结局包括寒颤控制时间、寒颤复发和产妇恶心的发生率。
本分析纳入了20项随机对照试验，共1983例患者。与生理盐水相比，有效治疗寒颤的比值比（OR[95%可信区间]）的网状估计值为：右美托咪定（38.1[14.2至111.5]）、曲马多（33.6[15.1至81.8]）、纳布啡（26.2[10.8至80.2]）、哌替啶（20.9[6.2至73.1]）、昂丹司琼（6.6[2.2至23.2]）和可乐定（3.2[0.6至14.9]）。根据累积排名曲线下面积得分（括号内）对寒颤控制的干预措施排名顺序为：右美托咪定（0.87）>曲马多（0.85）>纳布啡（0.74）>哌替啶（0.66）>昂丹司琼（0.41）>可乐定（0.3）>阿米替林（0.03）。右美托咪定在寒颤控制时间、寒颤复发和产妇恶心方面也是排名最高的干预措施。我们判断右美托咪定和纳布啡的证据确定性为中等，其他所有干预措施的证据确定性为低。
本网状Meta分析确定了四种有效治疗椎管内麻醉下剖宫产患者寒颤的静脉治疗方法：右美托咪定、曲马多、纳布啡和哌替啶。右美托咪定在所有结局方面都是排名最高的干预措施。
