Neuraxial adjuvants for prevention of perioperative shivering during cesarean section: A network meta-analysis following the PRISMA guidelines

Table 1 Characteristics of included trials and patients

First author, year	Size	Intraoperative ambient temperature	Type of anesthesia	Administration method	Local anesthetic	Intervention	Outcomes
Palmer et al[15], 1995	28	Unclear	SA	Intrathecal	5% lidocaine	Fentanyl vs Placebo	③④
Shehabi et al[16], 1990	62	21 °C	EA	Extradural	0.5% bupivacaine	Fentanyl vs Placebo	①
Han et al[17], 2014	60	Unclear	EA	Extradural	0.75% ropivacaine	Fentanyl vs Dexmedetomidine vs Placebo	③
Shami et al[34], 2016	150	24-26 °C	CSEA	Intrathecal	0.5% hyperbaric bupivacaine	Pethidine vs Placebo	③④⑤⑥
Techanivate et al[33], 2005	60	23 °C	SA	Intrathecal	0.5% hyperbaric bupivacaine plus 0.2 mg morphine	Fentanyl vs Placebo	③④⑤⑥
Roy et al[18], 2004	40	21–23 °C	SA	Intrathecal	0.75% hyperbaric bupivacaine plus 0.15 mg morphine	Pethidine vs Placebo	①
Qi et al[19], 2016	118	Unclear	SA	Intrathecal	0.5% bupivacaine	Dexmedetomidine vs Morphine vs Placebo	③④
Chen et al[31], 2010	64	Unclear	SA	Intrathecal	0.75% ropivacaine	Sufentanil vs Placebo	③④⑤⑥
Bachmann-Mennenga et al[21], 2005	60	Unclear	EA	Extradural	1% ropivacaine	Sufentanil vs Placebo	③④⑤⑥
Abdollahpour et al[10], 2015	75	Unclear	SA	Intrathecal	0.5% bupivacaine	Midazolam vs Sufentani vs Placebo	③⑤
He et al[7], 2017	90	22–28 °C	SA	Intrathecal	0.5% hyperbaric bupivacaine	Dexmedetomidine vs Placebo	③④⑥
Nasseri et al[22], 2017	50	22–26 °C	SA	Intrathecal	0.5% hyperbaric bupivacaine	Dexmedetomidine vs Placebo	③⑤⑥
de Figueiredo Locks et al[3], 2012	80	Unclear	SA	Intrathecal	0.5% hyperbaric bupivacaine	Sufentanil vs Placebo	①
Rastegarian et al[9], 2013	100	Unclear	SA	Intrathecal	5% hyperbaric lidocaine	Pethidine vs Placebo	③④⑤⑥
Khan et al[6], 2011	72	21–23 °C	SA	Intrathecal	0.5% hyperbaric bupivacaine	Pethidine vs Placebo	③⑤⑥
Hong et al[23], 2005	120	23–25 °C	CSEA	Intrathecal	0.5% bupivacaine	Morphine vs Pethidine vs Placebo	①
Agrawal et al[24], 2016	60	Unclear	SA	Intrathecal	0.3% bupivacaine	Morphine vs Fentanyl vs Placebo	③④⑤⑥
Hanoura et al[25], 2013	50	Unclear	CSEA	Extradural	0.5% hyperbaric bupivacaine (intrathecal) 0.25% bupivacaine plus 100ug fentanyl (extradural)	Dexmedetomidine vs Placebo	③④⑤⑥
Anaraki et al[26], 2012	156	21–23°C	SA	Intrathecal	0.5% hyperbaric bupivacaine	Pethidine vs Placebo	③④⑥
Bajwa et al[27], 2012	100	Unclear	SA	Intrathecal	0.5% hyperbaric bupivacaine	Clonidine vs Placebo	③④
Bi et al[28], 2017	60	Unclear	CSEA	Intrathecal	0.5% bupivacaine	Dexmedetomidine vs Placebo	③④
Yousef et al[29], 2010	90	Unclear	CSEA	Extradural	0.5% hyperbaric bupivacaine (intrathecal) 0.25% bupivacaine plus 100ug fentanyl (extradural)	Magnesium sulfate vs Placebo	③④⑤
Subedi et al[30], 2013	77	Unclear	SA	Intrathecal	0.5% hyperbaric bupivacaine	Tramadol vs Fentanyl	④⑤⑥
Qian et al[31], 2008	80	Unclear	CSEA	Intrathecal	0.6% ropivacaine	Sufentanil vs Placebo	③④⑤⑥
Faiz et al[8], 2013	72	23–25 °C	SA	Intrathecal	0.5% bupivacaine	Magnesium sulfate vs Placebo	①
Sadegh et al[32], 2011	80	24 °C	SA	Intrathecal	0.5% hyperbaric bupivacaine	Fentanyl vs Placebo	①②③⑤

SA: Spinal anesthesia; EA: Epidural anesthesia; CSEA: Combined spinal-epidural anesthesia; Outcomes: ① Shiver; ② Nausea; ③ Vomiting; ④ Pruritus; ⑤ Hypotension; ⑥ Bradycardia.

Table 2 SUCRA values and effect size in comparison to placebo

Nausea (Heterogeneity variance = 0.17)					Vomiting (Heterogeneity variance = 0.00)
Rank	Treatment	SUCRA	OR	95%CI	Rank	Treatment	SUCRA	OR	95%CI
1	Midazolam	86.10	0.20	(0.04, 0.96)	1	Fentanyl	79.90	0.25	(0.11, 0.56)
2	Fentanyl	77.10	0.34	(0.15, 0.79)	2	Sufentanil	70.70	0.34	(0.14, 0.80)
3	Pethidine	4.30	3.15	(1.04, 9.57)	3	Pethidine	1.10	3.71	(1.81, 7.58)
1	Clonidine	79.30	0.26	(0.06, 1.10)	1	Midazolam	89.90	0.11	(0.01, 1.00)
2	Tramadol	58.50	0.51	(0.06, 4.58)	2	Clonidine	69.30	0.35	(0.10, 1.26)
3	Magnesium sulfate	53.00	0.65	(0.09, 4.88)	3	Magnesium sulfate	48.70	0.65	(0.10, 4.10)
4	Dexmedetomidine	44.50	0.82	(0.38, 1.76)	4	Dexmedetomidine	38.10	0.87	(0.43, 1.74)
5	Sufentanil	37.20	0.97	(0.45, 2.06)	5	Placebo	32.20
6	Placebo	34.80			6	Morphine	20.10	1.42	(0.62, 3.26)
7	Morphine	25.10	1.30	(0.47, 3.56)
Pruritus (heterogeneity variance = 1.18)					Hypotension (heterogeneity variance = 0.15)
Rank	Treatment	SUCRA	OR	95%CI	Rank	Treatment	SUCRA	OR	95%CI
1	Morphine	22.60	6.54	(1.02, 41.88)	1	Midazolam	99.70	0.04	(0.01, 0.19)
2	Sufentanil	7.40	20.37	(2.44, 169.96)	2	Sufentanil	74.50	0.47	(0.23, 0.96)
1	Tramadol	76.90	0.40	(0.01, 12.33)	1	Magnesium sulfate	56.50	0.68	(0.16, 2.87)
2	Clonidine	75.90	0.34	(0.00, 29.96)	2	Morphine	55.20	0.68	(0.11,4.42)
3	Dexmedetomidine	71.90	0.74	(0.13, 4.17)	3	Placebo	41.20
4	Placebo	68.00			4	Dexmedetomidine	32.50	1.22	(0.31, 4.85)
5	Magnesium sulfate	48.60	2.05	(0.08, 52.19)	5	Pethidine	31.70	1.18	(0.59, 2.36)
6	Pethidine	39.60	2.98	(0.50, 17.73)	6	Fentanyl	31.50	1.18	(0.52, 2.67)
7	Fentanyl	39.10	2.84	(0.58, 13.91)	7	Tramadol	27.30	1.39	(0.33, 5.77)
Bradycardia (heterogeneity variance = 0.00)
Rank	Treatment	SUCRA	OR	95%CI
1	Pethidine	82.30	0.32	(0.07, 1.42)
2	Dexmedetomidine	52.70	0.84	(0.14, 4.87)
3	Fentanyl	49.50	1.00	(0.06, 16.44)
4	Morphine	47.70	1.00	(0.02, 40.86)
5	Placebo	46.70
6	Sufentanil	39.10	1.21	(0.44, 3.37)
7	Tramadol	32.00	1.72	(0.07, 41.24)

SUCRA: Surface under the cumulative ranking curve.