Remifentanil  increased incidence of postoperative shivering compared with other opioids

Remifentanil is unique among the opioids in its extremely rapid onset of action. There have been several anecdotal reports of a high incidence of postoperative shivering associated with remifentanil administration compared with administration of other opioids, but other studies have shown that remifentanil anesthesia does not increase the incidence of postoperative shivering. In this study, we performed a meta-analysis of randomized controlled trials comparing the incidence of postoperative shivering in surgical patients following administration of remifentanil or fentanyl, alfentanil, and sufentanil.

Methods:

We performed a computerized search of PubMed from inception until March 1, 2013, using the following key words and their combinations: remifentanil, shivering, TIVA, propofol and side effect. The articles thus identified included prospective randomized trials in which the incidence of postoperative shivering associated with remifentanil was compared with that associated with another opioid. Meta-analysis was performed using Comprehensive Meta-analysis version 2.2.040(Biostat, Englewood, NJ, USA) and a DerSimonian and Laird random-effect model. The pooled effects estimates for binary variables were calculated as Risk ratio (RR) and expressed as relative risk values with 95% confidence intervals (CI).

Results:

Sixteen randomized controlled trials met our inclusion criteria. Overall, 3099 patients received remifentanil and 3093 patients received another opioid (fentanyl, alfentanil, or sufentanil). Remifentanil was associated with a significantly increased incidence of postoperative shivering compared with that of the other opioids (RR=2.19; CI, 1.78–2.72; P<0.0001; I²=0.00%). Heterogeneity of data was statistically refuted.

Conclusion:

Our meta-analysis shows that remifentanil was associated with an increased incidence of postoperative shivering compared with fentanyl, alfentanil, and sufentanil.