Pharmacological treatment of postoperative shivering: A quantitative systematic review of randomized controlled trials
Shivering is a frequent complication in the postoperative period. The relative efficacy of interventions that are used for the treatment of postoperative shivering is not well understood. We performed a systematic search (MEDLINE, EMBASE, Cochrane Library, hand searching, all languages, to August, 2...
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Veröffentlicht in: | Anesthesia and analgesia 2002-02, Vol.94 (2), p.453-460 |
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description | Shivering is a frequent complication in the postoperative period. The relative efficacy of interventions that are used for the treatment of postoperative shivering is not well understood. We performed a systematic search (MEDLINE, EMBASE, Cochrane Library, hand searching, all languages, to August, 2000) for full reports of randomized comparisons of any pharmacological antishivering intervention (active) with placebo (control) in the postoperative period. Dichotomous data on absence of further shivering after treatment and adverse effects were extracted from original reports. Relative risk (RR) and number-needed-to-treat (NNT) were calculated with 95% confidence interval (CI) using a fixed effect model. Data from 20 trials (944 adults received an active intervention, 413 were controls) were analyzed. Antishivering efficacy depended on the active regimen and the length of follow-up. Efficacy with meperidine 25 mg, clonidine 150 microg, ketanserin 10 mg, and doxapram 100 mg was reported in at least three trials; all were significantly more effective than control. After 1 min, the NNT of meperidine 25 mg for no further shivering compared with placebo was 2.7 (RR, 6.8; 95% CI, 2.5-18.5). After 5 min, the NNT of meperidine 25 mg was 1.3 (RR, 9.6; 95% CI, 5.7-16), the NNT of clonidine 150 microg was 1.3 (RR, 6.8; 95% CI, 3.3-14.2), the NNT of doxapram 100 mg was 1.7 (RR 4.0; 95% CI, 2.4-6.5), and the NNT of ketanserin 10 mg was 2.3 (RR 3.1; 95% CI, 1.9-5.1). After 10 min, the NNT of meperidine 25 mg was 1.5 (RR 4.0; 95% CI, 2.5-6.2). After 15 min, the NNT of ketanserin 10 mg was 3.3 (RR 1.5; 95% CI, 1.2-1.9). Long-term outcome data were lacking. There were not enough data for alfentanil, fentanyl, morphine, nalbuphine, lidocaine, magnesium, metamizol, methylphenidate, nefopam, pentazocine, and tramadol to draw meaningful conclusions. Reporting of adverse drug reactions was sparse. Fewer than two shivering patients need to be treated with meperidine 25 mg, clonidine 150 microg, or doxapram 100 mg for one to stop shivering within 5 min who would have continued to shiver had they all received a placebo.
Less than two shivering patients need to be treated with meperidine 25 mg, clonidine 150 microg, or doxapram 100 mg for one to stop shivering within 5 min who would have continued to shiver had they all received a placebo. |
doi_str_mv | 10.1097/00000539-200202000-00043 |
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Less than two shivering patients need to be treated with meperidine 25 mg, clonidine 150 microg, or doxapram 100 mg for one to stop shivering within 5 min who would have continued to shiver had they all received a placebo.</description><identifier>ISSN: 0003-2999</identifier><identifier>EISSN: 1526-7598</identifier><identifier>DOI: 10.1097/00000539-200202000-00043</identifier><identifier>PMID: 11812718</identifier><identifier>CODEN: AACRAT</identifier><language>eng</language><publisher>Hagerstown, MD: Lippincott</publisher><subject>Adrenergic alpha-Agonists - therapeutic use ; Analgesics, Opioid - therapeutic use ; Anesthesia ; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy ; Biological and medical sciences ; Clonidine - therapeutic use ; General anesthesia. Technics. Complications. Neuromuscular blocking. Premedication. Surgical preparation. Sedation ; Humans ; Ketanserin - therapeutic use ; Lidocaine - therapeutic use ; Medical sciences ; Meperidine - therapeutic use ; Postoperative Complications - drug therapy ; Randomized Controlled Trials as Topic ; Shivering - drug effects</subject><ispartof>Anesthesia and analgesia, 2002-02, Vol.94 (2), p.453-460</ispartof><rights>2002 INIST-CNRS</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c416t-fd64ae57b21866c596529e096444261c8bce6e20ed9d4c030855bc440c8b85173</citedby><cites>FETCH-LOGICAL-c416t-fd64ae57b21866c596529e096444261c8bce6e20ed9d4c030855bc440c8b85173</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>315,781,785,27929,27930</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=13454675$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/11812718$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>KRANKE, Peter</creatorcontrib><creatorcontrib>EBERHART, Leopold H</creatorcontrib><creatorcontrib>ROEWER, Norbert</creatorcontrib><creatorcontrib>TRAMER, Martin R</creatorcontrib><title>Pharmacological treatment of postoperative shivering: A quantitative systematic review of randomized controlled trials</title><title>Anesthesia and analgesia</title><addtitle>Anesth Analg</addtitle><description>Shivering is a frequent complication in the postoperative period. The relative efficacy of interventions that are used for the treatment of postoperative shivering is not well understood. We performed a systematic search (MEDLINE, EMBASE, Cochrane Library, hand searching, all languages, to August, 2000) for full reports of randomized comparisons of any pharmacological antishivering intervention (active) with placebo (control) in the postoperative period. Dichotomous data on absence of further shivering after treatment and adverse effects were extracted from original reports. Relative risk (RR) and number-needed-to-treat (NNT) were calculated with 95% confidence interval (CI) using a fixed effect model. Data from 20 trials (944 adults received an active intervention, 413 were controls) were analyzed. Antishivering efficacy depended on the active regimen and the length of follow-up. Efficacy with meperidine 25 mg, clonidine 150 microg, ketanserin 10 mg, and doxapram 100 mg was reported in at least three trials; all were significantly more effective than control. After 1 min, the NNT of meperidine 25 mg for no further shivering compared with placebo was 2.7 (RR, 6.8; 95% CI, 2.5-18.5). After 5 min, the NNT of meperidine 25 mg was 1.3 (RR, 9.6; 95% CI, 5.7-16), the NNT of clonidine 150 microg was 1.3 (RR, 6.8; 95% CI, 3.3-14.2), the NNT of doxapram 100 mg was 1.7 (RR 4.0; 95% CI, 2.4-6.5), and the NNT of ketanserin 10 mg was 2.3 (RR 3.1; 95% CI, 1.9-5.1). After 10 min, the NNT of meperidine 25 mg was 1.5 (RR 4.0; 95% CI, 2.5-6.2). After 15 min, the NNT of ketanserin 10 mg was 3.3 (RR 1.5; 95% CI, 1.2-1.9). Long-term outcome data were lacking. There were not enough data for alfentanil, fentanyl, morphine, nalbuphine, lidocaine, magnesium, metamizol, methylphenidate, nefopam, pentazocine, and tramadol to draw meaningful conclusions. Reporting of adverse drug reactions was sparse. Fewer than two shivering patients need to be treated with meperidine 25 mg, clonidine 150 microg, or doxapram 100 mg for one to stop shivering within 5 min who would have continued to shiver had they all received a placebo.
Less than two shivering patients need to be treated with meperidine 25 mg, clonidine 150 microg, or doxapram 100 mg for one to stop shivering within 5 min who would have continued to shiver had they all received a placebo.</description><subject>Adrenergic alpha-Agonists - therapeutic use</subject><subject>Analgesics, Opioid - therapeutic use</subject><subject>Anesthesia</subject><subject>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</subject><subject>Biological and medical sciences</subject><subject>Clonidine - therapeutic use</subject><subject>General anesthesia. Technics. Complications. Neuromuscular blocking. Premedication. Surgical preparation. Sedation</subject><subject>Humans</subject><subject>Ketanserin - therapeutic use</subject><subject>Lidocaine - therapeutic use</subject><subject>Medical sciences</subject><subject>Meperidine - therapeutic use</subject><subject>Postoperative Complications - drug therapy</subject><subject>Randomized Controlled Trials as Topic</subject><subject>Shivering - drug effects</subject><issn>0003-2999</issn><issn>1526-7598</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2002</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpFkE1PxCAQhonR6Lr6FwwXvVWBAgVvxviVmOhBzw1Lp4ppywp0zfrrZbXqkGEG5n0heRDClJxSoqszsglR6oIRwvIipMjJyy00o4LJohJabaNZvisLprXeQ_sxvuUjJUruoj1KFWUVVTO0enw1oTfWd_7FWdPhFMCkHoaEfYuXPia_hGCSWwGOr3kPbng5xxf4fTRDcmmarGOCPvcWB1g5-NiYgxka37tPaLD1Qwq-63KbgjNdPEA7bS5wONU5er6-erq8Le4fbu4uL-4Ly6lMRdtIbkBUC0aVlFZoKZgGoiXnnElq1cKCBEag0Q23pCRKiIXlnOSJErQq5-jk591l8O8jxFT3LlroOjOAH2NdUZ4xMJqF6kdog48xQFsvg-tNWNeU1Bvm9S_z-o95_c08W4-mP8ZFD82_cYKcBceTwMSMuM1grIv_upILLitRfgFK4Iuy</recordid><startdate>20020201</startdate><enddate>20020201</enddate><creator>KRANKE, Peter</creator><creator>EBERHART, Leopold H</creator><creator>ROEWER, Norbert</creator><creator>TRAMER, Martin R</creator><general>Lippincott</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20020201</creationdate><title>Pharmacological treatment of postoperative shivering: A quantitative systematic review of randomized controlled trials</title><author>KRANKE, Peter ; EBERHART, Leopold H ; ROEWER, Norbert ; TRAMER, Martin R</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c416t-fd64ae57b21866c596529e096444261c8bce6e20ed9d4c030855bc440c8b85173</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2002</creationdate><topic>Adrenergic alpha-Agonists - therapeutic use</topic><topic>Analgesics, Opioid - therapeutic use</topic><topic>Anesthesia</topic><topic>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</topic><topic>Biological and medical sciences</topic><topic>Clonidine - therapeutic use</topic><topic>General anesthesia. Technics. Complications. Neuromuscular blocking. Premedication. Surgical preparation. Sedation</topic><topic>Humans</topic><topic>Ketanserin - therapeutic use</topic><topic>Lidocaine - therapeutic use</topic><topic>Medical sciences</topic><topic>Meperidine - therapeutic use</topic><topic>Postoperative Complications - drug therapy</topic><topic>Randomized Controlled Trials as Topic</topic><topic>Shivering - drug effects</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>KRANKE, Peter</creatorcontrib><creatorcontrib>EBERHART, Leopold H</creatorcontrib><creatorcontrib>ROEWER, Norbert</creatorcontrib><creatorcontrib>TRAMER, Martin R</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Anesthesia and analgesia</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>KRANKE, Peter</au><au>EBERHART, Leopold H</au><au>ROEWER, Norbert</au><au>TRAMER, Martin R</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Pharmacological treatment of postoperative shivering: A quantitative systematic review of randomized controlled trials</atitle><jtitle>Anesthesia and analgesia</jtitle><addtitle>Anesth Analg</addtitle><date>2002-02-01</date><risdate>2002</risdate><volume>94</volume><issue>2</issue><spage>453</spage><epage>460</epage><pages>453-460</pages><issn>0003-2999</issn><eissn>1526-7598</eissn><coden>AACRAT</coden><abstract>Shivering is a frequent complication in the postoperative period. The relative efficacy of interventions that are used for the treatment of postoperative shivering is not well understood. We performed a systematic search (MEDLINE, EMBASE, Cochrane Library, hand searching, all languages, to August, 2000) for full reports of randomized comparisons of any pharmacological antishivering intervention (active) with placebo (control) in the postoperative period. Dichotomous data on absence of further shivering after treatment and adverse effects were extracted from original reports. Relative risk (RR) and number-needed-to-treat (NNT) were calculated with 95% confidence interval (CI) using a fixed effect model. Data from 20 trials (944 adults received an active intervention, 413 were controls) were analyzed. Antishivering efficacy depended on the active regimen and the length of follow-up. Efficacy with meperidine 25 mg, clonidine 150 microg, ketanserin 10 mg, and doxapram 100 mg was reported in at least three trials; all were significantly more effective than control. After 1 min, the NNT of meperidine 25 mg for no further shivering compared with placebo was 2.7 (RR, 6.8; 95% CI, 2.5-18.5). After 5 min, the NNT of meperidine 25 mg was 1.3 (RR, 9.6; 95% CI, 5.7-16), the NNT of clonidine 150 microg was 1.3 (RR, 6.8; 95% CI, 3.3-14.2), the NNT of doxapram 100 mg was 1.7 (RR 4.0; 95% CI, 2.4-6.5), and the NNT of ketanserin 10 mg was 2.3 (RR 3.1; 95% CI, 1.9-5.1). After 10 min, the NNT of meperidine 25 mg was 1.5 (RR 4.0; 95% CI, 2.5-6.2). After 15 min, the NNT of ketanserin 10 mg was 3.3 (RR 1.5; 95% CI, 1.2-1.9). Long-term outcome data were lacking. There were not enough data for alfentanil, fentanyl, morphine, nalbuphine, lidocaine, magnesium, metamizol, methylphenidate, nefopam, pentazocine, and tramadol to draw meaningful conclusions. Reporting of adverse drug reactions was sparse. Fewer than two shivering patients need to be treated with meperidine 25 mg, clonidine 150 microg, or doxapram 100 mg for one to stop shivering within 5 min who would have continued to shiver had they all received a placebo.
Less than two shivering patients need to be treated with meperidine 25 mg, clonidine 150 microg, or doxapram 100 mg for one to stop shivering within 5 min who would have continued to shiver had they all received a placebo.</abstract><cop>Hagerstown, MD</cop><pub>Lippincott</pub><pmid>11812718</pmid><doi>10.1097/00000539-200202000-00043</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
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subjects | Adrenergic alpha-Agonists - therapeutic use Analgesics, Opioid - therapeutic use Anesthesia Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy Biological and medical sciences Clonidine - therapeutic use General anesthesia. Technics. Complications. Neuromuscular blocking. Premedication. Surgical preparation. Sedation Humans Ketanserin - therapeutic use Lidocaine - therapeutic use Medical sciences Meperidine - therapeutic use Postoperative Complications - drug therapy Randomized Controlled Trials as Topic Shivering - drug effects |
title | Pharmacological treatment of postoperative shivering: A quantitative systematic review of randomized controlled trials |
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