PMID- 32847522 OWN - NLM STAT- MEDLINE DCOM- 20210906 LR - 20210906 IS - 1471-2253 (Electronic) IS - 1471-2253 (Linking) VI - 20 IP - 1 DP - 2020 Aug 26 TI - Effect of intrathecal lipophilic opioids on the incidence of shivering in women undergoing cesarean delivery after spinal anesthesia: a systematic review and bayesian network meta- analysis of randomized controlled trials. PG - 214 LID - 10.1186/s12871-020-01116-5 [doi] LID - 214 AB - BACKGROUND: Shivering is a common side effect in women having cesarean delivery (CD) under spinal anesthesia, which can be bothersome to the patient, and it can also interfere with perioperative monitoring. In several studies, the intrathecal (IT) addition of a lipophilic opioid to local anesthetics has been shown to decrease the incidence of shivering. OBJECTIVE: We performed this network meta-analysis to evaluate the effects of intrathecal lipophilic opioids in preventing the incidence of shivering in patients undergoing CD. METHODS: This review was planned according to the PRISMA for Network Meta-Analysis (PRISMA-NMA) guidelines. An English literature search of multiple electronic databases was conducted. We included randomized controlled trials (RCTs) that reported on the incidence of shivering, with study groups receiving either IT fentanyl, sufentanil, or meperidine in women undergoing CD under spinal anesthesia. Quality of the studies was assessed using the modified Oxford scoring system. Using random-effects modeling, dichotomous data were extracted and summarized using odds ratio (OR) with a 95% credible interval (CrI). Statistical analysis was conducted using R studio version 1.0.153 - Inc. RESULTS: Twenty-one studies consisting of 1433 patients (Control group: 590 patients in twenty-one studies; Fentanyl group:199 patients in seven studies; Sufentanil group: 156 patients in five studies; Meperidine group: 488 patients in ten studies) met the inclusion criteria for this systematic review investigating the effect of intrathecal lipophilic opioids in preventing the incidence of shivering in women undergoing cesarean delivery under spinal anesthesia. Methodological validity scores ranged from 3 to 7. The Bayesian mixed network estimate showed the incidence of shivering was significantly lower with IT fentanyl (pooled odds ratio (OR): 0.13; 95% credible interval (CrI): 0.04 to 0.35; P = 0.0004) and IT meperidine (OR: 0.12; 95% CrI: 0.05 to 0.29; P < 0.00001), but not with IT sufentanil (OR: 0.37; 95% CrI: 0.11 to 1.22; P = 0.23). The IT fentanyl group had a significantly lower incidence of intraoperative discomfort [Risk Ratio (RR): 0.19; 95% CI: 0.10-0.35; P < 0.00001], the IT sufentanil group had a significantly higher incidence of pruritus (RR: 6.18; 95% CI: 1.18-32.46; P = 0.03) The IT meperidine group had a significantly lower incidence of intraoperative discomfort (2.7% vs. 13.6%; RR: 0.22; 95% CI: 0.09-0.55; P = 0.001), but there was a significant increase in nausea and vomiting (IT meperidine group vs. Control group: 42.7% vs. 19.4%; RR: 2.56; 95% CI: 1.14-5.75; P = 0.02). Meta-regression analysis based on the opioid dose and quality of the study did not impact the final inference of our result. CONCLUSION: IT fentanyl significantly decreased the incidence of shivering in women undergoing CD under spinal anesthesia without increasing maternal adverse events, confirming that routine use in this patient population is a good choice. IT sufentanil did not decrease the incidence of shivering. IT meperidine decreased the incidence and severity of shivering, but its use was also associated with significant nausea and vomiting. FAU - Subramani, Yamini AU - Subramani Y AD - Department of Anesthesia and Perioperative Medicine, Schulich School of Medicine, & Dentistry, Western University, London Health Sciences Centre- University Hospital, (LHSC-UH) , London, Ontario, Canada. Yamini.subramani@lhsc.on.ca. FAU - Nagappa, Mahesh AU - Nagappa M AD - Department of Anesthesia and Perioperative Medicine, Schulich School of Medicine, & Dentistry, Western University, London Health Sciences Centre- University Hospital, (LHSC-UH) , London, Ontario, Canada. FAU - Kumar, Kamal AU - Kumar K AD - Department of Anesthesia and Perioperative Medicine, Schulich School of Medicine, & Dentistry, Western University, London Health Sciences Centre- Victoria Hospital, (LHSC-VH) , London, Ontario, Canada. FAU - Fochesato, Lee-Anne AU - Fochesato LA AD - Department of Anesthesia and Perioperative Medicine, London Health Sciences Centre and St. Joseph's Health Care, Western University, London, Ontario, Canada. FAU - Chohan, Moaz Bin Yunus AU - Chohan MBY AD - Department of Anesthesia and Perioperative Medicine, London Health Sciences Centre and St. Joseph's Health Care, Western University, London, Ontario, Canada. FAU - Zhu, Yun Fei AU - Zhu YF AD - Department of Anesthesia and Perioperative Medicine, Schulich School of Medicine, & Dentistry, Western University, London Health Sciences Centre- University Hospital, (LHSC-UH) , London, Ontario, Canada. FAU - Armstrong, Kevin AU - Armstrong K AD - Department of Anesthesia and Perioperative Medicine, London Health Sciences Centre and St. Joseph's Health Care, Western University, London, Ontario, Canada. FAU - Singh, Sudha Indu AU - Singh SI AD - Department of Anesthesia and Perioperative Medicine, Schulich School of Medicine, & Dentistry, Western University, London Health Sciences Centre- University Hospital, (LHSC-UH) , London, Ontario, Canada. LA - eng PT - Journal Article PT - Meta-Analysis PT - Research Support, Non-U.S. Gov't PT - Systematic Review DEP - 20200826 PL - England TA - BMC Anesthesiol JT - BMC anesthesiology JID - 100968535 RN - 0 (Analgesics, Opioid) RN - AFE2YW0IIZ (Sufentanil) RN - UF599785JZ (Fentanyl) SB - IM MH - Analgesics, Opioid/*administration & dosage/adverse effects MH - Anesthesia, Obstetrical/adverse effects/methods MH - Anesthesia, Spinal/adverse effects/*methods MH - Bayes Theorem MH - Cesarean Section/*methods MH - Female MH - Fentanyl/administration & dosage/adverse effects MH - Humans MH - Incidence MH - Injections, Spinal/adverse effects/*methods MH - Network Meta-Analysis MH - Postoperative Nausea and Vomiting/chemically induced MH - Pregnancy MH - Randomized Controlled Trials as Topic/*methods MH - Shivering/*drug effects/physiology MH - Sufentanil/administration & dosage/adverse effects PMC - PMC7448354 COIS- None of the authors declared any competing interests. EDAT- 2020/08/28 06:00 MHDA- 2021/09/07 06:00 PMCR- 2020/08/26 CRDT- 2020/08/28 06:00 PHST- 2020/04/27 00:00 [received] PHST- 2020/08/04 00:00 [accepted] PHST- 2020/08/28 06:00 [entrez] PHST- 2020/08/28 06:00 [pubmed] PHST- 2021/09/07 06:00 [medline] PHST- 2020/08/26 00:00 [pmc-release] AID - 10.1186/s12871-020-01116-5 [pii] AID - 1116 [pii] AID - 10.1186/s12871-020-01116-5 [doi] PST - epublish SO - BMC Anesthesiol. 2020 Aug 26;20(1):214. doi: 10.1186/s12871-020-01116-5.