Dexmedetomidine as a neuraxial adjuvant for prevention of perioperative shivering: Meta-analysis of randomized controlled trials

Abstract

BackgroundDexmedetomidine, a highly selective α2-adrenoceptor agonist, has been investigated for anti-shivering effects in some trials. This current meta-analysis was conducted to evaluate the effectiveness of dexmedetomidine as a neuraxial adjuvant in preventing perioperative shivering.MethodsThis systematic review and meta-analysis was registered in PROSPERO [www.crd.york.ac.uk/PROSPERO] with the unique identification number CRD42017055991. The electronic databases PubMed, Embase, Cochrane Central Register of Controlled Trials (CENTRAL) were searched to select high-quality randomized controlled trials (RCTs) that evaluated the anti-shivering efficacy for neuraxial application dexmedetomidine as local anesthetic adjuvant. Effects were summarized using pooled risk ratios (RRs), weighed mean differences (MDs), or standardized mean differences (SMDs) and corresponding 95% confidence intervals (Cls) with random effect model. Heterogeneity assessment, sensitivity analysis, and publication bias were performed. The primary outcome was perioperative shivering.ResultsA total of 1760 patients from 24 studies were included in this meta-analysis. Compared with the placebo, dexmedetomidine reduced the incidence of perioperative shivering (RR: 0.34; 95% Cl: 0.21 to 0.55; P < 0.00001), with a maximum effective dose of 5μg via subarachnoid space injection (RR: 0.55; 95% CI: 0.32 to 0.92; P = 0.02), especially in cesarean section (RR: 0.20; 95% CI: 0.09 to 0.45; P = 0.0001). Dexmedetomidine also could improve the characteristics of the block, with an increase only in the incidence of bradycardia (RR: 2.11; 95% CI: 1.23 to 3.60; P = 0.006). No significant difference could be found compared dexmedetomidine with other adjuvants, except morphine.ConclusionsThis meta-analysis shows that dexmedetomidine as a neuraxial adjuvant had statistically significant efficacy on prevention of perioperative shivering. Moreover, dexmedetomidine could improve the characteristics of the block. However, the potential induction of bradycardia should be taken seriously.

Comparative evaluation of intrathecal bupivacaine alone and bupivacaine combined with dexmedetomidine in cesarean section using spinal anesthesia: a meta-analysis

“…No significant difference was found between the 3- and 10-µg doses, which is consistent with the findings by Zhang et al. 45 showing that 10 µg of DEX in SA failed to show superiority over 5 µg of DEX in the prevention of perioperative shivering.…”

Neuraxial adjuvants for prevention of perioperative shivering during cesarean section: A network meta-analysis following the PRISMA guidelines

“…As our results indicated, clonidine had a weak preventive effect on shivering. Dexmedetomidine can quickly be absorbed and subsequently agitate α 2 -ARs in the spinal cord, leading to the inhibition of sympathetic activity and central thermoregulation[45]. The attenuation of hyperadrenergic response to perioperative stress could be another mechanism of action of dexmedetomedine for shivering control.…”

The preventive effect of dexmedetomidine on adverse reactions induced by uterotonics in cesarean section: a meta-analysis

“…(3)Intervention: placebo(saline) was used in the control group and dexmedetomidine was used in the observation group. (6) Dexmedetomidine used in combination with other drugs in treatment; (7)No data provided for the calculating of adverse reactions. (8) Republished literatures.…”

“…Studied has been reported that it can reduce the incidence of nausea, vomiting and chilla during spinal anesthesia in cesarean section [4,5,6,7] . And in recent years, there is a increasing number of randomized controlled trials(RCTs) involving the use of DEX in cesarean section with the use of uterotonic agents.…”