Efficiency and safety of ondansetron in preventing postanaesthesia shivering

Abstract

Introduction Shivering is one of the most frequent complications of operation during the postanaesthesia period. Ondansetron has been proved to be valid in preventing postanaesthesia shivering (PAS) in several studies. However, its efficiency and safety are still disputable. We therefore performed an updated meta-analysis of randomised controlled trials (RCTs) for evaluation and to clarify this issue. Methods A literature search using the PubMed, Embase™ and Cochrane Library databases was performed (from inception to January 2015). RCTs that evaluated the efficiency and safety of ondansetron in the prevention of PAS were included in the meta-analysis. The primary outcome measure was incidence of PAS, and secondary outcomes included subgroup analysis and the side effects of ondansetron. Results A total of 8 RCTs containing 905 subjects were identified as suitable for this review. Compared with placebo, ondansetron was associated with a significant reduction of PAS (relative risk [RR]: 0.33, 95% confidence interval [CI]: 0.19-0.58, p=0.0001) while no difference was detected between ondansetron and pethidine (RR: 0.89, 95% CI: 0.41-1.94, p=0.78). There was no significant difference between ondansetron and placebo or pethidine in terms of risk of bradycardia but ondansetron was associated with a lower risk of hypotension (RR: 0.26, 95% CI: 0.08-0.79, p=0.020) than placebo. There was no difference in hypotension when ondansetron was compared with pethidine. Conclusions Ondansetron can prevent PAS effectively and reduce the risk of hypotension.

Keywords: Meta-analysis; Ondansetron; Pethidine; Shivering.

Figure 1

Flowchart of studies included in review

Figure 2

Risk of bias

Figure 3

Forest plot comparing the antishivering effect of ondansetron with placebo and with pethidine. A Mantel–Haenszel random effects model was used for meta-analysis. Risk ratios are shown with 95% confidence intervals.

Figure 4

Subgroup analysis by dose of ondansetron: Forest plot comparing ondansetron with placebo. A Mantel–Haenszel random effects model was used for meta-analysis. Risk ratios are shown with 95% confidence intervals.

Figure 5

Bradycardia: Forest plot comparing ondansetron with placebo and with pethidine. A Mantel–Haenszel random effects model was used for meta-analysis. Risk ratios are shown with 95% confidence intervals.

Figure 6

Hypotension: Forest plot comparing ondansetron with placebo and with pethidine. A Mantel–Haenszel random effects model was used for meta-analysis. Risk ratios are shown with 95% confidence intervals.