Adjuvant low-dose intrathecal meperidine cuts incidence of spinal shivering
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).