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Background <p>5-HT<sub>3</sub> receptor antagonists, including granisetron, have demonstrated antiemetic effects and the ability to prevent perioperative shivering. We conducted a systematic review of randomized clinical trials to investigate granisetron’s preventive effects on shivering in surgical patients undergoing general or neuraxial anesthesia.</p> Methods <p>We searched PubMed, Embase, Web of Science, and the Cochrane Central Register of Controlled Trials from inception to January 7, 2025, without language restrictions, and simultaneously searched study protocols in four registries. Randomized controlled trials comparing granisetron versus placebo in surgical patients were included. We excluded studies in which patients underwent surgeries with cardiopulmonary bypass or in which patients were not expected to be extubated after surgery. The primary outcome was the incidence of shivering, calculated as a risk ratio with 95% CI using a random-effects model. A trial sequential analysis (TSA) of the primary outcome was performed to reduce type 1 errors from repeated meta-analyses, calculating the required information size. The risk of bias was assessed using the Revised Cochrane risk of bias 2 tool.</p> Results <p>Twenty-four trials, totaling 2,165 patients (1,166 and 999 patients in the granisetron and control groups, respectively), were included. Our meta-analysis showed a significantly lower incidence of shivering in surgical patients who received granisetron (risk ratio, 0.34; 95% CI, 0.28–0.41; <i>I</i><sup>2</sup> = 9%). The Grading of Recommendation Assessment, Development, and Evaluation assessment for granisetron’s effect on shivering prevention was moderate. When only low risk-of-bias trials were included, the Z-cumulative curve crossed the TSA boundary of benefit, confirming a significant reduction in shivering incidence in the granisetron group. The optimal granisetron dose, however, remains unclear in this meta-analysis.</p> Conclusion <p>Our meta-analysis and TSA demonstrated that granisetron administration significantly reduced the incidence of shivering in patients undergoing surgery. While evidence regarding the general effect of granisetron on shivering is extensive, future studies should focus on determining the optimal dosage.</p> Trial registration <p>This meta-analysis is registered on PROSPERO(CRD42024616645).</p>

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Granisetron for prevention of postoperative shivering in surgical patients: a systematic review and meta-analysis

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年9月30日

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  • Tetsuhito Masubuchi,
  • Kazuhiro Minoguchi,
  • Hiromasa Kawakami,
  • Takahiro Mihara,
  • Hitoshi Sato,
  • Takahisa Goto

摘要

Background

5-HT3 receptor antagonists, including granisetron, have demonstrated antiemetic effects and the ability to prevent perioperative shivering. We conducted a systematic review of randomized clinical trials to investigate granisetron’s preventive effects on shivering in surgical patients undergoing general or neuraxial anesthesia.

Methods

We searched PubMed, Embase, Web of Science, and the Cochrane Central Register of Controlled Trials from inception to January 7, 2025, without language restrictions, and simultaneously searched study protocols in four registries. Randomized controlled trials comparing granisetron versus placebo in surgical patients were included. We excluded studies in which patients underwent surgeries with cardiopulmonary bypass or in which patients were not expected to be extubated after surgery. The primary outcome was the incidence of shivering, calculated as a risk ratio with 95% CI using a random-effects model. A trial sequential analysis (TSA) of the primary outcome was performed to reduce type 1 errors from repeated meta-analyses, calculating the required information size. The risk of bias was assessed using the Revised Cochrane risk of bias 2 tool.

Results

Twenty-four trials, totaling 2,165 patients (1,166 and 999 patients in the granisetron and control groups, respectively), were included. Our meta-analysis showed a significantly lower incidence of shivering in surgical patients who received granisetron (risk ratio, 0.34; 95% CI, 0.28–0.41; I2 = 9%). The Grading of Recommendation Assessment, Development, and Evaluation assessment for granisetron’s effect on shivering prevention was moderate. When only low risk-of-bias trials were included, the Z-cumulative curve crossed the TSA boundary of benefit, confirming a significant reduction in shivering incidence in the granisetron group. The optimal granisetron dose, however, remains unclear in this meta-analysis.

Conclusion

Our meta-analysis and TSA demonstrated that granisetron administration significantly reduced the incidence of shivering in patients undergoing surgery. While evidence regarding the general effect of granisetron on shivering is extensive, future studies should focus on determining the optimal dosage.

Trial registration

This meta-analysis is registered on PROSPERO(CRD42024616645).