Abstract
The aim of this systematic review and meta-analysis is to evaluate the pros and cons of adjuvant low dose intrathecal meperidine for spinal anaesthesia. We searched electronic databases for randomized controlled trials using trial sequential analysis (TSA) to evaluate the incidence of reduced rescue analgesics, shivering, pruritus, nausea and vomiting when applying adjuvant intrathecal meperidine. Twenty-eight trials with 2216 patients were included. Adjuvant intrathecal meperidine, 0.05–0.5 mg kg−1, significantly reduced incidence of shivering (relative risk, RR, 0.31, 95% confidence interval, CI, 0.24 to 0.40; TSA-adjusted RR, 0.32, 95% CI, 0.25 to 0.41). Intrathecal meperidine also effectively reduced need for intraoperative rescue analgesics (RR, 0.27, 95% CI, 0.12 to 0.64; TSA-adjusted RR, 0.27, 95% CI, 0.08 to 0.91) and the incidence of pruritus was unaffected (RR, 2.31, 95% CI, 0.94 to 5.70; TSA-adjusted RR, 1.42, 95% CI, 0.87 to 2.34). However, nausea and vomiting increased (RR, 1.84, 95% CI, 1.29 to 2.64; TSA-adjusted RR, 1.72, 95% CI, 1.33 to 2.23; RR, 2.23, 95% CI, 1.23 to 4.02; TSA-adjusted RR,1.96, 95% CI, 1.20 to 3.21). Under TSA, these results provided a sufficient level of evidence. In conclusion, adjuvant low dose intrathecal meperidine effectively attenuates spinal anaesthesia-associated shivering and reduces rescue analgesics with residual concerns for the nausea and vomiting.
Highlights
The aim of this systematic review and meta-analysis is to evaluate the pros and cons of adjuvant low dose intrathecal meperidine for spinal anaesthesia
This systematic review and meta-analysis with trial sequential analysis focuses on whether low dose, 0.05–0.5 mg kg−1, intrathecal meperidine adjuvant with local anaesthetics could prevent shivering without significant side effects during spinal anaesthsia
We excluded: 1) interventions delivered through oral, parenteral or epidural routes; 2) different regimens or doses of local anaesthetics given between the experiment and the control; 3) meperidine given alone without local anaesthetics; 4) non-elective surgery; and 5) duplicate reporting of patient cohorts
Summary
The aim of this systematic review and meta-analysis is to evaluate the pros and cons of adjuvant low dose intrathecal meperidine for spinal anaesthesia. Adjuvant low dose intrathecal meperidine effectively attenuates spinal anaesthesia-associated shivering and reduces rescue analgesics with residual concerns for the nausea and vomiting. Due to the above adverse effects, combining local anaesthetics with relatively lower dosage, 0.05–0.5 mg kg−1 intrathecal meperidine, were suggested to provide adequate analgesia with less side effects[21,22,23,24]. Controversy remains about intrathecal local anaesthetics combined with lower dose meperidine causing adverse effects such as bradycardia, hypotension, pruritus, nausea and vomiting[21,25,26,27,31,33]. This systematic review and meta-analysis with trial sequential analysis focuses on whether low dose, 0.05–0.5 mg kg−1, intrathecal meperidine adjuvant with local anaesthetics could prevent shivering without significant side effects during spinal anaesthsia
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