Effect of transcutaneous electrical acupoint stimulation on post-anesthetic shivering: a meta-analysis and trial sequential analysis.

OBJECTIVE

To evaluate the effect of transcutaneous electrical acupoint stimulation (TEAS) on post-anesthetic shivering in adult patients undergoing surgery under general or neuraxial anesthesia.

METHODS

PubMed, Web of Science, Embase, the Cochrane Library, and China National Knowledge Infrastructure databases were searched for randomized controlled trials (RCTs) comparing TEAS with placebo and reporting on shivering. The primary outcome was the incidence of post-anesthetic shivering. Secondary outcomes included the incidence of postoperative nausea (PON), postoperative vomiting (POV), and postoperative nausea and vomiting (PONV). Trial sequential analysis (TSA) was also carried out to test the robustness of our results.

RESULTS

This meta-analysis included a total of 10 RCTs comparing TEAS to placebo with 445 and 444 patients, respectively. TEAS reduced the incidence of post-anesthetic shivering from 25% to 10% [risk ratio (RR) 0.41; 95% confidence interval (95% CI) 0.30-0.55; P < 0.05; I 2 = 0%] in comparison with placebo, without significant publication bias. Besides, the incidence of PON (RR = 0.37, 95% CI = 0.19-0.74; P < 0.05), POV (RR = 0.15, 95% CI = 0.06-0.38; P < 0.05), and PONV (RR = 0.24, 95% CI = 0.15-0.38; P < 0.05) was lower in the TEAS groups versus placebo. In addition, TSA indicated that there was enough evidence for these outcomes and further studies are unlikely to alter the conclusions regarding the incidence of post-anesthetic shivering and PONV.

CONCLUSION

This meta-analysis suggested that TEAS can effectively reduce the incidence of post-anesthetic shivering and PONV, and further studies are unlikely to alter the conclusions.