Nefopam for the prevention of perioperative shivering: a meta-analysis of randomized controlled trials

Meng Lv, Xuetao Wang, Wendong Qu, Mengjie Liu, Yuelan Wang, Meng Lv, Xuetao Wang, Wendong Qu, Mengjie Liu, Yuelan Wang

Abstract

Background: Shivering is a frequent complication following surgery and anaesthesia. A large variety of studies have been reported that nefopam may be efficacious for the prevention and treatment of perioperative shivering. Regrettably, there is still no conclusion of the efficacy and safety of nefopam for the prevention of perioperative shivering. The aim of this analysis is to evaluate the efficacy of nefopam for the prevention of perioperative shivering in patients undergoing different types of anaesthesia compared with placebo group and other active interventions.

Methods: PubMed, EMBASE, Cochrane Central Register of Control Trials were systematically searched for potentially relevant trials. Trial quality and extracted data were evaluated by two authors independently. Dichotomous data on the absence of shivering was extracted and analysed by using relative risk (RR) with 95% confidence interval (CI). Continuous outcome was abstracted and analysed by using weighted mean difference (WMD) with 95% confidence interval (CI). Outcome data was analysed by using random effect model or fixed effect model in accordance with heterogeneity.

Results: Compared with placebo, prophylactic administration of nefopam significantly reduced the risk of perioperative shivering not only in the patients under general anaesthesia but also neuraxial anaesthesia (RR 0.08; 95% CI 0.05-0.13). As compared with clonidine, nefopam was more efficacious in the prevention of perioperative shivering (RR 0.34; 95% CI 0.17-0.70). Nefopam has no influence on the extubation time (WMD 0.92; 95% CI -0.15-1.99).

Conclusion: Our analysis has demonstrated that nefopam is associated with the decrease of risk of perioperative shivering following anaesthesia without influencing the extubation time.

Figures

Fig. 1
Fig. 1
Flow chart of analyzed studies
Fig. 2
Fig. 2
Risk of bias graph
Fig. 3
Fig. 3
The effect of nefopam on the perioperative shivering
Fig. 4
Fig. 4
Funnel plots for the influence of nefopam on the incidence of peri-operative shivering
Fig. 5
Fig. 5
The effect of nefopam on perioperative shivering under different anesthesia
Fig. 6
Fig. 6
The infuence of nefopam on the extubation time
Fig. 7
Fig. 7
The influence of nefopam on the peri-operative shivering in comparison with clonidine

References

    1. Li X, Zhou M, Xia Q, Li W, Zhang Y. Effect of parecoxib sodium on postoperative shivering: a randomised, double-blind clinical trial. Eur J Anaesthesiol. 2014;31(4):225–30.
    1. Barker SJ, Shah NK. The effects of motion on the performance of pulse oximeters in volunteers (revised publication) Anesthesiology. 1997;86(1):101–8.
    1. Horn EP, Sessler DI, Standl T, Schroeder F, Bartz HJ, Beyer JC, et al. Non-thermoregulatory shivering in patients recovering from isoflurane or desflurane anesthesia. Anesthesiology. 1998;89(4):878–86.
    1. Jabbary Moghaddam M, Ommi D, Mirkheshti A, Dabbagh A, Memary E, Sadeghi A, et al. Effects of clonidine premedication upon postoperative shivering and recovery time in patients with and without opium addiction after elective leg fracture surgeries. Anesthesiol Pain Med. 2013;2(3):107–10.
    1. Mittal G, Gupta K, Katyal S, Kaushal S. Randomised double-blind comparative study of dexmedetomidine and tramadol for post-spinal anaesthesia shivering. Indian J Anaesth. 2014;58(3):257–62.
    1. Yousuf B, Samad K, Ullah H, Hoda MQ. Efficacy of tramadol in preventing postoperative shivering using thiopentone or propofol as induction agent: A randomized controlled trial. J Anaesthesiol Clin Pharmacol. 2013;29(4):521–5.
    1. Kim YA, Kweon TD, Kim M, Lee HI, Lee YJ, Lee KY. Comparison of meperidine and nefopam for prevention of shivering during spinal anesthesia. Korean J Anesthesiol. 2013;64(3):229–33.
    1. Mohta M, Kumari N, Tyagi A, Sethi AK, Agarwal D, Singh M. Tramadol for prevention of postanaesthetic shivering: a randomised double-blind comparison with pethidine. Anaesthesia. 2009;64(2):141–6.
    1. Tie HT, Su GZ, He K, Liang SR, Yuan HW, Mou JH. Efficacy and safety of ondansetron in preventing postanesthesia shivering: a meta-analysis of randomized controlled trials. BMC Anesthesiol. 2014;14:12.
    1. Kranke P, Eberhart LH, Roewer N, Tramer MR. Single-Dose parenteral pharmacological interventions for the prevention of postoperative shivering: A quantitative systematic review of randomized controlled trials. Anesth Analg. 2004;99(3):718–27.
    1. Kranke P, Eberhart LH, Roewer N, Tramer MR. Pharmacological treatment of postoperative shivering: a quantitative systematic review of randomized controlled trials. Anesth Analg. 2002;94(2):453–60.
    1. Park SM, Mangat HS, Berger K, Rosengart AJ. Efficacy spectrum of antishivering medications: meta-analysis of randomized controlled trials. Crit Care Med. 2012;40(11):3070–82.
    1. Bilotta F, Pietropaoli P, Sanita R, Liberatori G, Rosa G. Regional anesthesia and pain medicine. 2002. Nefopam and tramadol for the prevention of shivering during neuraxial anesthesia; pp. 380–4.
    1. Heel RC, Brogden RN, Pakes GE, Speight TM, Avery GS. Nefopam: a review of its pharmacological properties and therapeutic efficacy. Drugs. 1980;19(4):249–67.
    1. Pillans PI, Woods DJ. Adverse reactions associated with nefopam. N Z Med J. 1995;108(1008):382–4.
    1. Bhatt AM, Pleuvry BJ, Maddison SE. Respiratory and metabolic effects of oral nefopam in human volunteers. Br J Clin Pharmacol. 1981;11(2):209–11.
    1. Rosland JH, Hole K. The effect of nefopam and its enantiomers on the uptake of 5-hydroxytryptamine, noradrenaline and dopamine in crude rat brain synaptosomal preparations. J Pharm Pharmacol. 1990;42(6):437–8.
    1. Hocker J, Gruenewald M, Meybohm P, Schaper C, Scholz J, Steinfath M, et al. Nefopam but not physostigmine affects the thermoregulatory response in mice via alpha(2)-adrenoceptors. Neuropharmacology. 2010;58(2):495–500.
    1. Deeks JJ, Higgins JPT, Altman DG. Cochrane handbook for systematic reviews of interventions. Chichester: John Wiley & Sons, Ltd; 2008. Analysing data and undertaking meta-analyses; pp. 243–96.
    1. Higgins JPT, Altman DG, Gøtzsche PC, Jüni P, Moher D, Oxman AD, et al. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. 2011.
    1. Egger M, Davey Smith G, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. BMJ (Clin Res Ed) 1997;315(7109):629–34.
    1. Schimmenti G, Caruso A, Di Giacinto C, Bellia C, Re MR, Scarpuzza E. Nefopam for the prevention of shivering induced by local-regional anesthesia. Anaesth Intensive Care Italy. 2004;55(4):303–12.
    1. Rosa G, Dell’Utri D, Conti G, Pelaia P, Cogliati A, Orsi P, et al. Archives of internal medicine. 1997. Efficacy of nefopam for the prevention and treatment of amphotericin B-induced shivering; pp. 1589–92.
    1. Ferri L, Bertelli G, Innocenti S, Di Grancio R, Tinagli F. The treatment of postoperative shivering with nefopam hydrochloride. Minerva Anestesiol. 1993;59(6):317–20.
    1. Izzo V, Mariconti P, Tiengo M. Action and effectiveness of nefopam chloride in the control of postoperative shivering. Minerva Anestesiol. 1991;57(9):760–2.
    1. Rosa G, Pinto G, Orsi P, De Blasi RA, Conti G, Sanita R, et al. Control of post anaesthetic shivering with nefopam hydrochloride in mildly hypothermic patients after neurosurgery. Acta Anaesthesiol Scand. 1995;39(1):90–5.
    1. Rohm KD, Riechmann J, Boldt J, Schuler S, Suttner SW, Piper SN. Physostigmine for the prevention of postanaesthetic shivering following general anaesthesia - a placebo-controlled comparison with nefopam. Anaesthesia. 2005;60(5):433–8.
    1. Bilotta F, Ferri F, Giovannini F, Pinto G, Rosa G. Nefopam or clonidine in the pharmacologic prevention of shivering in patients undergoing conscious sedation for interventional neuroradiology. Anaesthesia. 2005;60(2):124–8.
    1. Piper SN, Röhm KD, Suttner SW, Maleck WH, Kranke P, Boldt J. Anaesthesia. 2004. A comparison of nefopam and clonidine for the prevention of postanaesthetic shivering: a comparative, double-blind and placebo-controlled dose-ranging study; pp. 559–64.
    1. Piper SN, Suttner SW, Schmidt CC, Maleck WH, Kumle B, Boldt J. Nefopam and clonidine in the prevention of postanaesthetic shivering. Anaesthesia. 1999;54(7):695–9.
    1. Piper SN, Schmidt CC, Suttner SW, Kumle B, Triem JG, Maleck WH, et al. Anasthesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS. 1998. Prophylactic nefopam administration for post-anesthetic shivering; pp. 786–9.
    1. Tempia A, Livigni S, Castino PM, Fiore G, De Caroli D, Pattono R. The use of nefopam in the prophylaxis and treatment of postoperative shivering. Minerva Anestesiol. 1992;58(9):547–51.
    1. Bilotta F, Pietropaoli P, La Rosa I, Spinelli F, Rosa G. Effects of shivering prevention on haemodynamic and metabolic demands in hypothermic postoperative neurosurgical patients. Anaesthesia. 2001;56(6):514–9.
    1. Kamal MM, Hussein NS. Prevention of postspinal shivering by using ketamine plus midazolam in comparison with nefopam. Egypt J Chem. 2011;27(1):1–5.
    1. Rohm KD, Riechmann J, Boldt J, Schuler S, Suttner SW, Piper SN. Physostigmine for the prevention of postanaesthetic shivering following general anaesthesia - A placebo-controlled comparison with nefopam. Anaesthesia. 2005;60(5):433–8.
    1. Sessler DI. Perioperative heat balance. Anesthesiology. 2000;92(2):578–96.
    1. Bilotta F, Pietropaoli P, La Rosa I, Spinelli F, Rosa G. Effects of shivering prevention on haemodynamic and metabolic demands in hypothermic postoperative neurosurgical patients. Anaesthesia. 2001;56(6):514–519.
    1. Kurz A, Sessler DI, Narzt E, Bekar A, Lenhardt R, Huemer G, et al. Postoperative hemodynamic and thermoregulatory consequences of intraoperative core hypothermia. J Clin Anesth. 1995;7(5):359–66.
    1. Kim YM, Lim BG, Kim H, Kong MH, Lee MK, Lee IO. Slow injection of nefopam reduces pain intensity associated with intravenous injection: a prospective randomized trial. J Anesth. 2014;28(3):399–406.
    1. Evans MS, Lysakowski C, Tramer MR. Nefopam for the prevention of postoperative pain: quantitative systematic review. Br J Anaesth. 2008;101(5):610–7.
    1. Alfonsi P, Adam F, Passard A, Guignard B, Sessler DI, Chauvin M. Nefopam, a Nonsedative Benzoxazocine Analgesic, Selectively Reduces the Shivering Threshold in Unanesthetized Subjects. Anesthesiology. 2004;100(1):37–43.
    1. Delaunay L, Bonnet F, Liu N, Beydon L, Catoire P, Sessler DI. Clonidine comparably decreases the thermoregulatory thresholds for vasoconstriction and shivering in humans. Anesthesiology. 1993;79(3):470–4.
    1. Kurz A, Ikeda T, Sessler DI, Larson MD, Bjorksten AR, Dechert M, et al. Meperidine decreases the shivering threshold twice as much as the vasoconstriction threshold. Anesthesiology. 1997;86(5):1046–54.
    1. Annadata R, Sessler DI, Tayefeh F, Kurz A, Dechert M. Desflurane slightly increases the sweating threshold but produces marked, nonlinear decreases in the vasoconstriction and shivering thresholds. Anesthesiology. 1995;83(6):1205–11.
    1. De Witte JL, Kim JS, Sessler DI, Bastanmehr H, Bjorksten AR. Tramadol reduces the sweating, vasoconstriction, and shivering thresholds. Anesth Analg. 1998;87(1):173–9.
    1. Wrench IJ, Cavill G, Ward JE, Crossley AW. Comparison between alfentanil, pethidine and placebo in the treatment of post-anaesthetic shivering. Br J Anaesth. 1997;79(4):541–2.

Source: PubMed

Sponsor e collaboratori

Condizioni mediche

Interventi farmacologici

3
Sottoscrivi