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Adjuvant low-dose intrathecal meperidine cuts incidence of spinal shivering

17 Nov 2017
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Adjuvant intrathecal meperidine in low doses is effective for preventing anaesthesia-associated spinal shivering and reduces the need for rescue analgesics, according to a new meta-analysis.

Pooled data from 21 randomized controlled trials (RCTs), corresponding to 1,535 subjects, showed that adjuvant low-dose meperidine significantly reduced the incidence of shivering compared with controls (risk ratio [RR], 0.31; 95 percent CI, 0.24 to 0.40; p<0.00001). Moreover, relative risk reduction (RRR) was calculated to be 66.1 percent while the absolute RR (ARR) was 29.2 percent.

The effect of adjuvant low-dose intrathecal meperidine on shivering incidence, based on the four-level intensity scale, was examined in 15 RCTs corresponding to 1,198 patients. A meta-analysis of these trials found a preventive effect for grade I (RR, 0.62; 0.41 to 0.94; p=0.02) and II (RR, 0.35; 0.23 to 0.53; p<0.00001) shivering.

The risks for grade III (RR, 0.26; 0.16 to 0.41; p<0.00001) and IV (RR, 0.15; 0.08 to 0.28; p<0.00001) shivering were likewise reduced by the meperidine intervention.

Compared with controls, those who received the meperidine intervention also had a significantly reduced need for intraoperative rescue analgesics (RR, 0.27; 0.12 to 0.64; p=0.003), with RRR and ARR of 73.3 and 10.6 percent, respectively.

In contrast, adjuvant low-dose intrathecal meperidine significantly increased the risk of nausea (RR, 1.84; 1.29 to 2.64; p=0.0009) and vomiting (RR, 2.23; 1.23 to 4.02; p=0.008), but only moderately statistically increased the incidence of pruritus (RR, 2.31; 0.94 to 5.70; p=0.07).

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Most Read Articles
Jairia Dela Cruz, 26 Jun 2018
The monoclonal antibody denosumab is safe and effective for use in patients on glucocorticoids and at risk of developing fractures, with a recent study showing that the drug performs better than risedronate in increasing bone mineral density (BMD).
Dr Renly Lim, 01 Aug 2018
Palliative care uses an integrated, multidisciplinary approach to reduce suffering and to improve the quality of life of patients battling with life-threatening illnesses.
Rachel Soon, 24 Apr 2018

MIMS Pharmacist presents an overview of CoQ10's physiological role, as well as contemporary research on its pharmacology and effects.

Stephen Padilla, 20 Sep 2018
Romosozumab therapy for 12 months is well tolerated and effective in increasing spine and hip bone mineral density (BMD) in men with osteoporosis, according to a recent study.