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The use of fentanyl administered intrathecally can lessen
the intensity and severity of shivering and improve spinal anesthesia in
cesarean delivery.
Based on a recent systematic review and network meta-analysis of randomized controlled trials published in August issue of BMC Anesthesiology, intrathecal (IT) fentanyl outshined other two IT lipophilic opioids (sufentanil and meperidine) in reducing shivering in case of cesarean delivery (CD) under spinal anesthesia and improved analgesia. It was found safe in these women as it did not increase the maternal adverse events.
Women having CD under spinal anesthesia commonly experience shivering, which can intervene with perioperative monitoring. While considering PRISMA for Network Meta-Analysis guidelines, Yamini Subramani et al. reviewed the effects of IT lipophilic opioids in avoiding the incidence of shivering in these women.
Database search comprised of randomized controlled trials that described the occurrence of shivering, in women undergoing CD receiving either IT meperidine, fentanyl or sufentanil under spinal anesthesia. The modified Oxford scoring system was used to evaluate the studies’ quality.
A total of 21 studies comprising of 1433 patients (as described in table 1) fulfilled the inclusion criteria.
The methodological validity scores fluctuated from 3 to 7. The women with IT fentanyl and IT meperidine revealed a significantly lower incidence of shivering, however not with the use of IT sufentanil. Lesser incidence of intraoperative discomfort was reported by IT fentanyl group and higher incidence of pruritus was reported by women in IT sufentanil group.
The IT meperidine group had a considerably lower incidence of intraoperative discomfort (2.7% versus 13.6%), nevertheless, there was a momentous increase in nausea and vomiting in IT meperidine group versus the control group (42.7% versus 19.4%).
BMC Anesthesiology
Effect of intrathecal lipophilic opioids on the incidence of shivering in women undergoing cesarean delivery after spinal anesthesia: a systematic review and bayesian network meta- analysis of randomized controlled trials
Yamini Subramani et al.
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