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Adjuvant low-dose intrathecal meperidine cuts incidence of spinal shivering

17 Nov 2017
The opioid epidemic in the US has presented a complicated moral dilemma to doctors when treating potential drug abusers.

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
Pearl Toh, 10 Jul 2018
A dual-hormone artificial pancreas (DAP) with a rapid delivery of insulin and pramlintide in a fixed ratio improves glycaemic control and reduces glucose variability in adults with type 1 diabetes (T1D) compared with first-generation artificial pancreas delivering insulin alone, according to a study presented at ADA 2018.
20 Feb 2019
A recent study has shown that compounded topical pain creams are only as effective as placebo creams in the treatment of localized chronic pain. Their costs are also higher compared with approved compounds, which should discourage routine use.
Audrey Abella, 21 Dec 2018
Use of a single course of the intravenous iron preparation ferumoxytol may lead to sustained improvements in patient-reported outcomes (PROs) of individuals with iron deficiency anaemia (IDA) who had inadequate response to oral iron therapy, according to data presented at ASH 2018.
Saras Ramiya, 23 Oct 2018
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