The Effectiveness of Moxibustion: An Overview During 10 Years

Moxibustion has been used to treat various types of disease. However, there is still insufficient evidence regarding its effectiveness. This study was performed to summarize and evaluate the effectiveness of moxibustion. A search was performed for all randomized controlled trials in PubMed between January 1998 and July 2008 with no language restriction. The results yielded 47 trials in which six moxibustion types were applied to 36 diseases ranging from breech presentation to digestive disorders. Moxibustion was compared to three types of control group: general care, Oriental medical therapies or waiting list. Moxibustion was superior to the control in 14 out of 54 control groups in 46 studies. There were no significant differences among groups in 7 studies, and the outcome direction was not determined in 33 studies. Seven studies were included in a meta-analysis. Moxibustion was more effective than medication in two ulcerative colitis studies (relative risk (95% CI), 2.20 (1.37, 3.52),P= .001,I2= 0%). Overall, our results did not support the effectiveness of moxibustion in specific diseases due to the limited number and low quality of the studies and inadequate use of controls. In order to provide appropriate evidence regarding the effectiveness of moxibustion, more rigorous clinical trials using appropriate controls are warranted.

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Lidocaine vs. Other Local Anesthetics in the Development of Transient Neurologic Symptoms (TNS) Following Spinal Anesthesia: A Meta-Analysis of Randomized Controlled Trials

Journal of Clinical Medicine ◽

10.3390/jcm9020493 ◽

2020 ◽

Vol 9 (2) ◽

pp. 493 ◽

Cited By ~ 1

Author(s):

Chang-Hoon Koo ◽

Hyun-Jung Shin ◽

Sung-Hee Han ◽

Jung-Hee Ryu

Keyword(s):

Randomized Controlled Trials ◽

Spinal Anesthesia ◽

Local Anesthetics ◽

Meta Analysis ◽

Control Group ◽

Controlled Trials ◽

Control Groups ◽

Lidocaine Group ◽

Randomized Controlled ◽

Meta Analyses

The use of lidocaine in spinal anesthesia may increase the risk of transient neurological symptoms (TNS) according to previous meta-analyses. However, the previous meta-analyses lacked data on some other local anesthetics and thus, more evaluations are still needed to compare the effect of lidocaine on the development of TNS. The objective of this study was to compare the risk of TNS according to lidocaine versus other local anesthetics in patients undergoing spinal anesthesia. A total of 39 randomized controlled trials with 4733 patients were analyzed. The incidence of TNS was 10.8% in the lidocaine group and was 2.2% in the control groups (risk ratio (RR) 4.12, 95% confidence interval (CI) 3.13 to 5.43, p < 0.001). In subgroup analysis, lidocaine increased the incidence of TNS compared with other local anesthetics except mepivacaine, ropivacaine or sameridine. The risk of TNS was higher in the hyperbaric (p < 0.001) or isobaric lidocaine (p < 0.001) group compared with the control group, but there were no differences found between the two groups when hypobaric lidocaine was administered (p = 1.00). This study confirmed that lidocaine for spinal anesthesia still causes TNS more frequently than most other local anesthetics, especially when hyperbaric or isobaric lidocaine was used.

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Effects of the Small-Sided Soccer Games on Blood Pressure in Untrained Hypertensive Adults: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Healthcare ◽

10.3390/healthcare9030345 ◽

2021 ◽

Vol 9 (3) ◽

pp. 345

Author(s):

Filipe Manuel Clemente ◽

Rodrigo Ramirez-Campillo ◽

Hugo Sarmento

Keyword(s):

Systematic Review ◽

Blood Pressure ◽

Randomized Controlled Trials ◽

Diastolic Blood Pressure ◽

Meta Analysis ◽

Intervention Group ◽

Control Group ◽

Controlled Trials ◽

Control Groups ◽

Randomized Controlled

This systematic review with meta-analysis was conducted to assess the effects of small-sided games (SSGs)-based programs on the systolic and diastolic blood pressure of untrained hypertensive adults. The data sources utilized were Web of Science, Scopus, SPORTDiscus, and PubMed. The eligibility criteria were: (i) randomized controlled trials including a control group and an intervention group exclusively using soccer SSGs; (ii) intervention and control groups including an untrained hypertensive adult population; (iii) articles written in English; and (iv) only full-text and original articles. The database search initially identified 241 titles. From those, five articles were eligible for the systematic review and meta-analysis. The included randomized controlled studies involved five individual experimental groups and 88 participants, and 68 participants in the five control groups. The results showed a large and beneficial effect of SSG on systolic (ES = 1.69; 95% CI = 0.71 to 2.66; p = 0.001; I2 = 85.2%; Egger’s test p = 0.101) and diastolic blood pressure (ES = 2.25; 95% CI = 1.44 to 3.06; p < 0.001; I2 = 74.8%; Egger’s test p = 0.118) when compared to the control groups. The findings of the current systematic review and meta-analysis revealed consistent beneficial effects of recreational soccer SSGs on untrained men and women from the hypertensive population, although high levels of heterogeneity.

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Mycophenolate Mofetil in the Treatment of Steroid-Dependent or Frequently Relapsing Nephrotic Syndrome in Children: A Meta-Analysis

Frontiers in Pediatrics ◽

10.3389/fped.2021.671434 ◽

2021 ◽

Vol 9 ◽

Author(s):

Xin Xiang ◽

Shi-Yuan Qiu ◽

Mo Wang

Keyword(s):

Nephrotic Syndrome ◽

Mycophenolate Mofetil ◽

Randomized Controlled Trials ◽

Meta Analysis ◽

Control Group ◽

Controlled Trials ◽

Frequently Relapsing Nephrotic Syndrome ◽

Randomized Controlled ◽

Steroid Dependent

Objectives: This meta-analysis aims to evaluate the efficacy and safety of the mycophenolate mofetil (MMF) in the treatment of steroid-dependent nephrotic syndrome (SDNS) or frequently relapsing nephrotic syndrome (FRNS) in children.Methods: We searched for the studies especially the randomized controlled trials in PubMed, Cochrane Library, Embase, China National Knowledge Infrastructure, and Wan Fang database. The data were analyzed by Review Manager 5.3 software. We used the GRADE pro-Guideline Development Tool online software to evaluate the quality of evidence.Results: Finally, we identified 620 studies, of which we included five randomized controlled trials and one prospective cohort study with 447 children. The results showed the following: (1) the relapse-free survival rate within 1 year—the MMF group was superior to the levamisole group [ratio difference (RD) = 0.13, 95% CI (0.02, 0.24), P = 0.02] but not to the calcineurin inhibitors (CNIs) group [RD = −0.27, 95%CI (−0.40, −0.14), P < 0.0001]; (2) the number of relapses within 1 year—the MMF group was less than that in the CNIs and levamisole group [mean difference (MD) = −0.26, 95%CI (−0.45, −0.08), P = 0.005]; (3) the cumulative prednisone dosage—the MMF group was lower than that in the control group [standardized mean difference (SMD) = −0.32, 95%CI (−0.53, −0.11), P = 0.003]; (4) incidence of adverse reactions—there was no significant difference between the MMF group and the control group [RD = 0.02, 95%CI (−0.04, 0.09), P = 0.46].Conclusion: The therapy of mycophenolate mofetil in the treatment of SDNS or FRNS in children has a certain advantage in reducing the number of relapses and cumulative prednisone dosage within 1 year when compared with the CNIs and levamisole. However, due to the limited quantity and quality of the included studies, the conclusions above need to be confirmed by more high-quality randomized controlled trials.

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Clinical Effects of Baduanjin Qigong Exercise on Cancer Patients: A Systematic Review and Meta-Analysis on Randomized Controlled Trials

Evidence-based Complementary and Alternative Medicine ◽

10.1155/2021/6651238 ◽

2021 ◽

Vol 2021 ◽

pp. 1-10

Author(s):

Chi-Chun Kuo ◽

Chiao-Chen Wang ◽

Wei-Lun Chang ◽

Tzu-Ching Liao ◽

Pei-En Chen ◽

...

Keyword(s):

Quality Of Life ◽

Systematic Review ◽

Sleep Quality ◽

Cancer Patients ◽

Meta Analysis ◽

Control Group ◽

Controlled Trials ◽

Clinical Effects ◽

Randomized Controlled

Objective. Baduanjin is a traditional Chinese Qigong exercise for health improvement. However, a few studies were examining the association between Baduanjin Qigong exercise and cancer patients. This study is conducted to explore the clinical effects of the Baduanjin Qigong exercise among cancer patients. Methods. We conducted a systematic review and meta-analysis using randomized controlled trials to assess the effects of the Baduanjin Qigong exercise on cancer patients. We searched Cochrane Library, PubMed, Embase, and Airiti Library for all relevant studies from inception through December 31, 2020, without language limitations. Two authors independently screened selected studies, assessed the quality of included studies, and extracted information. Any disagreement was discussed with a third senior author. Summary estimates were obtained using meta-analysis with the random effects model. Results. Among the fourteen articles involved in the systematic review, ten studies were included in the meta-analysis. Cancer patients with moderate-severe cancer-related fatigue were significantly less in the Baduanjin group compared with the control group (odds ratio = 0.27; 95% confidence interval (CI) [0.17, 0.42]). Three studies used the questionnaire of Functional Assessment of Cancer Therapy-Breast Cancer (FACT-B) in the assessment of quality of life, and two used the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30). For FACT-B, the Baduanjin group scored significantly higher than the control group (mean difference = 11.04, 95% CI [9.56, 12.53]). For EORTC QLQ-C30, the Baduanjin group scored significantly higher than the control group (mean difference = 10.57, 95% CI [7.82, 13.32]). The Pittsburgh Sleep Quality Index (PSQI) score for sleep quality of the Baduanjin group is significantly lower than the control group (mean difference = −2.89, 95% CI [−3.48, −2.30]). Conclusion. In conclusion, we found the Baduanjin exercise had positive clinical effects on cancer patients. This meta-analysis not only supported that the Baduanjin exercise can alleviate the degree of cancer-related fatigue in patients but also improved their quality of life and sleep quality. Further long-term follow-up randomized controlled trials are warranted.

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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.

10.21203/rs.3.rs-25731/v2 ◽

2020 ◽

Author(s):

Yamini Subramani ◽

Mahesh Nagappa ◽

Kamal Kumar ◽

Lee-Anne Fochesato ◽

Moaz Bin Yunus Chohan ◽

...

Keyword(s):

Systematic Review ◽

Spinal Anesthesia ◽

Cesarean Delivery ◽

Lower Incidence ◽

Meta Analysis ◽

Control Group ◽

Controlled Trials ◽

Randomized Controlled ◽

Fentanyl Group

Abstract Background: Shivering is a common side effect in women having cesarean delivery (CD) under spinal anesthesia, which can be bothersome to the patient, and it can also interfere with perioperative monitoring. In several studies, the intrathecal (IT) addition of a lipophilic opioid to local anesthetics has been shown to decrease the incidence of shivering.Objective: We performed this network meta-analysis to evaluate the effects of intrathecal lipophilic opioids in preventing the incidence of shivering in patients undergoing CD. Methods: This review was planned according to the PRISMA for Network Meta-Analysis (PRISMA-NMA) guidelines. An English literature search of multiple electronic databases was conducted. We included randomized controlled trials (RCTs) that reported on the incidence of shivering, with study groups receiving either IT fentanyl, sufentanil, or meperidine in women undergoing CD under spinal anesthesia. Quality of the studies was assessed using the modified Oxford scoring system. Using random-effects modeling, dichotomous data were extracted and summarized using odds ratio (OR) with a 95% credible interval (CrI). Statistical analysis was conducted using R studio version 1.0.153 - Inc. Results: Twenty-one studies consisting of 1433 patients (Control group: 590 patients in twenty-one studies; Fentanyl group:199 patients in seven studies; Sufentanil group: 156 patients in five studies; Meperidine group: 488 patients in ten studies) met the inclusion criteria for this systematic review investigating the effect of intrathecal lipophilic opioids in preventing the incidence of shivering in women undergoing cesarean delivery under spinal anesthesia. Methodological validity scores ranged from 3 to 7. The Bayesian mixed network estimate showed the incidence of shivering was significantly lower with IT fentanyl (pooled odds ratio (OR): 0.13; 95% credible interval (CrI): 0.04 to 0.35; P = 0.0004) and IT meperidine (OR: 0.12; 95% CrI: 0.05 to 0.29; P < 0.00001), but not with IT sufentanil (OR: 0.37; 95% CrI: 0.11 to 1.22; P = 0.23). The IT fentanyl group had a significantly lower incidence of intraoperative discomfort [Risk Ratio (RR): 0.19; 95% CI: 0.10-0.35; P < 0.00001], the IT sufentanil group had a significantly higher incidence of pruritus (RR: 6.18; 95% CI: 1.18-32.46; P = 0.03) The IT meperidine group had a significantly lower incidence of intraoperative discomfort (2.7% vs. 13.6%; RR: 0.22; 95% CI: 0.09-0.55; P = 0.001), but there was a significant increase in nausea and vomiting (IT meperidine group vs. Control group: 42.7% vs. 19.4%; RR: 2.56; 95% CI: 1.14-5.75; P = 0.02). Meta-regression analysis based on the opioid dose and quality of the study did not impact the final inference of our result. Conclusion: IT fentanyl significantly decreased the incidence of shivering in women undergoing CD under spinal anesthesia without increasing maternal adverse events, confirming that routine use in this patient population is a good choice. IT sufentanil did not decrease the incidence of shivering. IT meperidine decreased the incidence and severity of shivering, but its use was also associated with significant nausea and vomiting.

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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.

10.21203/rs.3.rs-25731/v3 ◽

2020 ◽

Author(s):

Yamini Subramani ◽

Mahesh Nagappa ◽

Kamal Kumar ◽

Lee-Anne Fochesato ◽

Moaz Bin Yunus Chohan ◽

...

Keyword(s):

Spinal Anesthesia ◽

Cesarean Delivery ◽

Odds Ratio ◽

Meta Analysis ◽

Credible Interval ◽

Control Group ◽

Controlled Trials ◽

Randomized Controlled ◽

Fentanyl Group

Abstract Background: Shivering is a common side effect in women having cesarean delivery (CD) under spinal anesthesia, which can be bothersome to the patient, and it can also interfere with perioperative monitoring. In several studies, the intrathecal (IT) addition of a lipophilic opioid to local anesthetics has been shown to decrease the incidence of shivering. Objective: We performed this network meta-analysis to evaluate the effects of intrathecal lipophilic opioids in preventing the incidence of shivering in patients undergoing CD. Methods: This review was planned according to the PRISMA for Network Meta-Analysis (PRISMA-NMA) guidelines. An English literature search of multiple electronic databases was conducted. We included randomized controlled trials (RCTs) that reported on the incidence of shivering, with study groups receiving either IT fentanyl, sufentanil, or meperidine in women undergoing CD under spinal anesthesia. Quality of the studies was assessed using the modified Oxford scoring system. Using random-effects modeling, dichotomous data were extracted and summarized using odds ratio (OR) with a 95% credible interval (CrI). Statistical analysis was conducted using R studio version 1.0.153 - Inc.Results: Twenty-one studies consisting of 1433 patients (Control group: 590 patients in twenty-one studies; Fentanyl group:199 patients in seven studies; Sufentanil group: 156 patients in five studies; Meperidine group: 488 patients in ten studies) met the inclusion criteria for this systematic review investigating the effect of intrathecal lipophilic opioids in preventing the incidence of shivering in women undergoing cesarean delivery under spinal anesthesia. Methodological validity scores ranged from 3 to 7. The Bayesian mixed network estimate showed the incidence of shivering was significantly lower with IT fentanyl (pooled odds ratio (OR): 0.13; 95% credible interval (CrI): 0.04 to 0.35; P = 0.0004) and IT meperidine (OR: 0.12; 95% CrI: 0.05 to 0.29; P < 0.00001), but not with IT sufentanil (OR: 0.37; 95% CrI: 0.11 to 1.22; P = 0.23). The IT fentanyl group had a significantly lower incidence of intraoperative discomfort [Risk Ratio (RR): 0.19; 95% CI: 0.10-0.35; P < 0.00001], the IT sufentanil group had a significantly higher incidence of pruritus (RR: 6.18; 95% CI: 1.18-32.46; P = 0.03) The IT meperidine group had a significantly lower incidence of intraoperative discomfort (2.7% vs. 13.6%; RR: 0.22; 95% CI: 0.09-0.55; P = 0.001), but there was a significant increase in nausea and vomiting (IT meperidine group vs. Control group: 42.7% vs. 19.4%; RR: 2.56; 95% CI: 1.14-5.75; P = 0.02). Meta-regression analysis based on the opioid dose and quality of the study did not impact the final inference of our result.Conclusion: IT fentanyl significantly decreased the incidence of shivering in women undergoing CD under spinal anesthesia without increasing maternal adverse events, confirming that routine use in this patient population is a good choice. IT sufentanil did not decrease the incidence of shivering. IT meperidine decreased the incidence and severity of shivering, but its use was also associated with significant nausea and vomiting.

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Erythropoiesis Stimulating Agents (ESA) for the Treatment of Chemotherapy Induced Anemia in Patients with Hemoglobin Levels (Hb) <11g/Dl- a Systematic Review and Meta-Analysis

Blood ◽

10.1182/blood.v112.11.1305.1305 ◽

2008 ◽

Vol 112 (11) ◽

pp. 1305-1305 ◽

Cited By ~ 4

Author(s):

Luciano Paladini ◽

Otavio Clark ◽

Luciana Clark ◽

Tobias Engel ◽

Eneas Faleiros

Keyword(s):

Systematic Review ◽

Relative Risk ◽

Meta Analysis ◽

Mortality Rates ◽

Regulatory Agencies ◽

Controlled Trials ◽

Inclusion Criteria ◽

Control Groups ◽

Randomized Controlled

Abstract Background: Anemia is a frequent condition in patients receiving chemotherapy. ESA are effective to control this condition, but a recently published meta-analysis and warnings from regulatory agencies have pointed to a possible increase in mortality in these patients. Objective: Our aim was to evaluate the safety of ESA when used according to label indications, that is, for patients with chemotherapy induced anemia (rather than cancer induced anemia) with Hb<11g/dl. Methods: We performed a systematic review and meta-analysis of all randomized controlled trials comparing the use of ESA versus placebo (or no treatment) in patients with chemotherapy induced anemia, for whom ESAs where indicated if Hb dropped below 11g/dl. The primary end-point was mortality. We searched several databases, including MEDLINE, EMBASE, LILACS and CENTRAL, among others. All suitable papers were retrived and data regarding the quality of the studies and mortality rates were extracted. Then, we performed a meta-analysis of these trials, using RevMan 5.0 software. Results: □There were 17 studies, with 3788 patients, meeting our inclusion criteria. There were 566 deaths among the 2208 patients that received ESA and 488 among the 1580 on control groups. The meta-analysis showed no increase in mortality rates associated with the use of ESA (Relative risk (RR) = 0.95; IC 95% 0.88 to 1.03; P=0.22). Also, there was no heterogeneity in the analysis (I2=0%), showing that the results were consistent among the studies. When we analised the Hb cut-off point in 10g/dl, the meta-analysis results were similar (RR=0.97; IC 95% 0.87 to 1.07; P 0.52; I2=0%). Conclusion: When used as indicated on label, that is, for patients with chemotherapy induced anemia with Hb<11g/dl ESA are NOT associated with higher mortality rates and remain a safe option for these patients.

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Evaluating the Efficacy of Massage Intervention for the Treatment of Poststroke Constipation: A Meta-Analysis

Evidence-based Complementary and Alternative Medicine ◽

10.1155/2020/8934751 ◽

2020 ◽

Vol 2020 ◽

pp. 1-8 ◽

Cited By ~ 1

Author(s):

Qiu-Shuang Wang ◽

Ya Liu ◽

Xiang-Ni Zou ◽

Yan-Ling Ma ◽

Gen-Li Liu

Keyword(s):

Randomized Controlled Trials ◽

Meta Analysis ◽

Cochrane Library ◽

Control Group ◽

Controlled Trials ◽

Control Groups ◽

Stroke Event ◽

Randomized Controlled ◽

Significant Difference ◽

Massage Group

Background. It is essential to determine a safe and effective method for treating constipation after stroke. Massage has been widely used in recent years. However, meta-analysis data on the efficacy of massage for the treatment of constipation experienced after stroke are almost nonexistent. Objective. This review aimed to examine the effectiveness of using massage therapy to treat constipation in patients who suffered a stroke event. Methods. This systematic review adhered to the reporting guidelines for Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Electronic databases, including Cochrane Library, PubMed, EMBASE, Web of Science, China Biology Medicine, Wan Fang Data, VIP Database for Chinese Technical Periodicals, and National Knowledge Infrastructure, were searched for relevant studies on the efficacy of massage for the treatment of poststroke constipation. Rev-Man 5.3 software was used to analyze the study data. Results. A total of 11 randomized controlled trials with 1045 patients were included. A statistically significant difference in the total effective rates was found between the massage and control groups (OR = 4.96; 95% confidence interval (CI): 2.81, 8.76; P<0.001). Compared with the control groups, the massage group had markedly reduced incidences of constipation (OR = 0.34; 95% CI: 0.25, 0.47; P<0.001) and of four symptoms of discomfort (P<0.001). The frequency of defecation on day two and day three in the massage group was significantly higher than that in the control group (P<0.001). Conclusion. Our results strongly suggest that massage can effectively reduce the incidence and severity of constipation after stroke. However, large, multicenter, long-term, and high-quality randomized controlled trials need to be conducted to establish a definitive conclusion.

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What Do Meta-Analyses Have to Say About the Efficacy of Neurofeedback Applied to Children With ADHD? Review of Previous Meta-Analyses and a New Meta-Analysis

Journal of Attention Disorders ◽

10.1177/1087054718821731 ◽

2019 ◽

Vol 25 (4) ◽

pp. 473-485 ◽

Cited By ~ 5

Author(s):

Pablo Riesco-Matías ◽

José Ramón Yela-Bernabé ◽

Antonio Crego ◽

Elena Sánchez-Zaballos

Keyword(s):

Stimulant Medication ◽

Meta Analysis ◽

Controlled Trials ◽

Random Effects Model ◽

Adhd Symptoms ◽

Control Groups ◽

Children With Adhd ◽

Randomized Controlled ◽

Meta Analyses

Objective: We reviewed previously published meta-analyses of neurofeedback applied to children with ADHD and conducted a new meta-analysis of randomized controlled trials (RCTs) that updates previous results and incorporates methodological modifications. Method: Searches were carried out through PubMed, Sage, PsycINFO, SpringerLink, and Psicodoc. We used Hedges’ (adjusted) g and a random-effects model. To assess heterogeneity, Q and I2 were calculated. We performed different analyses depending on the control groups, ADHD symptoms, pre- and/or posttreament data used and symptom evaluator. Results: We reviewed seven meta-analyses, and 17 studies were incorporated into the meta-analysis. RCTs support the efficacy of neurofeedback applied to ADHD when most proximal evaluators assess symptoms. Neurofeedback significantly improves inattention symptoms when possibly blinded evaluators assess symptoms. The preliminary results suggest that stimulant medication is more effective than neurofeedback. Conclusion: New RCTs that establish links between ADHD symptom measurements, subjects’ learning after neurofeedback, and neurophysiological measures could improve the quality of the conclusions.

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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.

10.21203/rs.3.rs-25731/v1 ◽

2020 ◽

Author(s):

Yamini Subramani ◽

Mahesh Nagappa ◽

Kamal Kumar ◽

Lee-Anne Fochesato ◽

Moaz Bin Yunus Chohan ◽

...

Keyword(s):

Spinal Anesthesia ◽

Cesarean Delivery ◽

Lower Incidence ◽

Odds Ratio ◽

Meta Analysis ◽

Control Group ◽

Controlled Trials ◽

Randomized Controlled ◽

Fentanyl Group

Abstract Background Shivering is a common side effect in women having cesarean delivery (CD) under spinal anesthesia. It may be bothersome and can also interfere with perioperative monitoring. The intrathecal (IT) addition of a lipophilic opioid to local anesthetics has been shown to decrease the incidence of shivering in several studies in literature. Objective We performed this meta-analysis to evaluate the effects of intrathecal lipophilic opioids in preventing the incidence of shivering in patients undergoing CD. Methods This review was planned according to the PRISMA for Network Meta-Analysis (PRISMA-NMA) guidelines. An English literature search of multiple electronic databases was conducted. We included randomized controlled trials (RCTs) that reported on the incidence of shivering, with study groups receiving either IT fentanyl, sufentanil, or meperidine in women undergoing CD under spinal anesthesia. Quality of the studies was assessed using the modified oxford scoring system. Dichotomous data were extracted and summarized using Odds Ratio (OR) with 95% Credible intervals (CrI) using random-effects modeling. Statistical analysis was conducted using R studio version 1.0.153 - Inc. Results Twenty-one studies consisting of 1433 patients (Control group: 590 patients in twenty-one studies; Fentanyl group:199 patients in seven studies; Sufentanil group: 156 patients in five studies; Meperidine group: 488 patients in ten studies) met inclusion criteria for intrathecal lipophilic opioids to prevent the incidence of shivering in women undergoing cesarean delivery under spinal anesthesia. Methodological validity scores ranged from 3 to 7. The bayesian mixed network estimate showed the incidence of shivering was significantly lower with IT fentanyl (Pooled Odds Ratio (OR): 0.13; 95% Credible Interval (CrI): 0.04 to 0.35; P = 0.0004) and IT meperidine (OR: 0.12; 95% CrI: 0.05 to 0.29; P < 0.00001), but not with IT sufentanil (OR: 0.37; 95% CrI: 0.11 to 1.22; P = 0.23). The IT fentanyl group had a significantly lower incidence of intraoperative discomfort (RR: 0.19; 95% CI: 0.10–0.35; P < 0.00001), The IT sufentanil group had a significantly higher incidence of pruritus (RR: 6.18; 95% CI: 1.18–32.46; P = 0.03) The IT Meperidine group had a significantly lower incidence of intraoperative discomfort (2.7% vs. 13.6%; RR: 0.22; 95% CI: 0.09–0.55; P = 0.001), but there was a significant increase in nausea and vomiting (IT meperidine group vs. Control group: 42.7% vs. 19.4%; RR: 2.56; 95% CI: 1.14–5.75; P = 0.02). Meta-regression analysis based on the opioid dose and quality of the study did not impact the final inference of our result. Conclusion IT fentanyl significantly decreased the incidence of shivering in women undergoing CD under spinal anesthesia without increasing maternal adverse events, confirming that routine use in this patient population is a good choice. IT sufentanil did not decrease the incidence of shivering. IT meperidine also decreased the incidence and severity of shivering, but it was associated with significant nausea and vomiting.

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