Premedication with Granisetron Reduces Shivering during Spinal Anaesthesia in Children

5-HT3 receptor antagonists for the prevention of perioperative shivering undergoing spinal anaesthesia: a systematic review and meta-analysis of randomised controlled trials

OBJECTIVE

Perioperative shivering (POS) is a common complication in patients undergoing spinal anaesthesia. The present study investigated the efficacy of 5-HT₃ receptor antagonists in preventing POS following spinal anaesthesia.

DESIGN

Systematic review and meta-analysis.

DATA SOURCES

Pubmed, Embase, the Web of Science and Cochrane Library were searched from database establishment on 31 July 2019.

ELIGIBILITY CRITERIA

Randomised controlled trials that reported the effects of 5-HT₃ receptor antagonists in the prevention of POS in patients after spinal anaesthesia.

DATA EXTRACTION AND SYNTHESIS

Two reviewers independently extracted data. The primary outcome of the present study was the incidence of POS. The risk of bias for the included studies was assessed according to the Cochrane Handbook. The quality of primary outcome was evaluated by Grading of Recommendations Assessment, Development and Evaluation. Trial sequential analysis for the primary outcome was performed to reduce the type 1 error caused by repeated meta-analysis and the required information size was calculated.

RESULTS

A total of 13 randomised controlled trials consisting of 1139 patients were included. The overall incidence of POS was significantly lower in the 5-HT₃ receptor antagonists group (risk ratio 0.31; 95% CI 0.26 to 0.38; p<0.01; I²=0%). Subgroup analysis for different types of 5-HT₃ receptor antagonists and timing of administration produced similar results. Also, patients had a lower incidence of postoperative nausea and vomiting after administrating 5-HT3 receptor antagonists. No statistically significant differences in drug-related adverse effects were observed. Grading of Recommendations Assessment, Development and Evaluation revealed a high level of evidence. The cumulative z-curve crossed the trial sequential monitoring boundary.

CONCLUSIONS

The present study revealed that prophylactic 5-HT₃ receptor antagonists were an effective measure for reducing the incidence of POS in patients after spinal anaesthesia. However, further studies investigating the different types of surgeries are required.

PROSPERO REGISTRATION NUMBER

CRD42019148191.

Shivering prevention and treatment during cesarean delivery under neuraxial anesthesia: a systematic review

INTRODUCTION

Perioperative shivering during cesarean sections (CSs) under neuraxial anesthesia (NA) is clinically common but often under-treated. It may prominently increase oxygen consumption, which can be catastrophic for parturients with ischemic cardiovascular disease. Thus, the prevention and treatment of shivering may be of great significance in parturients. The purpose of this systematic review was to investigate the effectiveness of several drugs on shivering prevention and treatment during CSs under NA.

EVIDENCE ACQUISITION

A literature search was carried out using PubMed, EMBASE and the Cochrane Library to identify relevant studies. After literature screening and information extraction, a systematic review was performed.

EVIDENCE SYNTHESIS

Eighteen randomized controlled trials met the inclusion criteria. Intrathecal dexmedetomidine effectively reduced shivering, but effectiveness depended on the dose administered. Intrathecal fentanyl, intrathecal sufentanil, intrathecal meperidine, intravenous ketamine and intravenous tramadol were beneficial for reducing shivering during CSs under NA. MgSO4 administered intrathecally resulted in transient alleviation of shivering, and the effect did not persist. Two trials investigated the antishivering effect of intravenous ondansetron. The medication appeared to be effective in one trial, but ineffective in the other.

CONCLUSIONS

Appropriate use of dexmedetomidine, fentanyl, sufentanil, ketamine, meperidine, tramadol and MgSO4 may effectively reduce the incidence and severity of shivering during CSs under NA, while trials on the effect of intravenous ondansetron reached inconclusive results.

5-HT3 receptor antagonists for the prevention of postoperative shivering: a meta-analysis

Objective

We evaluated the efficacy of 5-HT3 receptor antagonists for the prevention of postoperative shivering.

Methods

We searched PubMed, the Cochrane Library, EMBASE and Web of Knowledge to find randomized controlled trials (RCT) of 5-HT3 receptor antagonists for the prevention of postoperative shivering. Two researchers independently screened studies, extracted data, and assessed quality in accordance with the inclusion and exclusion criteria, and then conducted a meta-analysis using RevMan 5.2.

Results

Ultimately, 14 RCTs that included 980 patients were included in the analysis. We found that: 1) the incidence of shivering was significantly lower in 5-HT3 groups than placebo groups (relative risk, [RR] = 0.48, 95% confidence interval [CI] 0.40 – 0.58); 2) there was no significant difference in the incidence of shivering between 5-HT3 groups and meperidine groups (RR = 0.89, 95% CI 0.60 – 1.34).

Conclusion

5-HT3 receptor antagonists appear to prevent postoperative shivering, with a broadly comparable efficacy to meperidine.

Prophylactic ondansetron does not prevent shivering or decrease shivering severity during cesarean delivery under combined spinal epidural anesthesia: a randomized trial

OBJECTIVES

Cesarean delivery is commonly performed under regional anesthesia, which is often associated with maternal shivering. This can cause distress and interfere with monitoring. The study objective was to evaluate the antishivering efficacy of ondansetron, which reduces the incidence and severity of shivering in nonobstetric patients. We hypothesized that there would be a significant decrease in the incidence and/or severity of shivering in women who are given intravenous ondansetron 8 mg before combined spinal epidural (CSE) anesthesia, when compared with placebo.

METHODS

This was a randomized, double-blinded, parallel-group, placebo-controlled trial of 118 women scheduled for elective cesarean surgery. Women received either intravenous ondansetron 8 mg (n = 58) or saline (n = 60) before CSE anesthesia (intrathecal hyperbaric bupivacaine 0.5% 2.2-2.5 mL plus fentanyl 15 μg). The incidence and severity of shivering, measured on a validated 5-point scale, and other outcomes, such as nausea, pruritus, headache, or satisfaction, were assessed at 3 time points during the surgery and postoperative period.

RESULTS

The incidence of shivering at any time point did not differ significantly between groups: ondansetron 41% versus placebo 47% (P = 0.54). The incidence of severe shivering at any time was not significantly different: ondansetron 32% versus placebo 33% (P = 0.79). There were no significant differences between the groups for any secondary outcomes.

CONCLUSIONS

Intravenous ondansetron 8 mg before performing CSE anesthesia in women undergoing elective cesarean delivery does not decrease the incidence or severity of shivering.