Abstract Background Postanesthetic shivering (PAS) is a common and distressing complication in the post-anesthesia care unit (PACU). Meperidine has traditionally been used for PAS treatment, but interest in non-opioid alternatives has increased. We compared the effectiveness and safety of dexmedetomidine versus meperidine for the treatment of PAS. Methods This retrospective cohort study included 484 adult patients who developed PAS in the PACU after surgery between January and December 2024 and received intravenous dexmedetomidine or meperidine as the initial treatment. The primary outcome was treatment failure, defined as the need for rescue anti-shivering medication before PACU discharge. Secondary outcomes included hypotension, bradycardia, postoperative nausea and vomiting, clinically significant respiratory depression, PACU length of stay, and PACU fentanyl consumption. After 1:1 propensity score matching, 149 matched pairs were analyzed. Results In the matched cohort, dexmedetomidine was associated with a lower rate of treatment failure than meperidine (3.4% vs. 10.1%; OR 0.33, 95% CI 0.12–0.92; p = 0.033). Hypotension was more frequent in the dexmedetomidine group (6.7% vs. 1.3%; OR 5.00, 95% CI 1.10–22.82; p = 0.038). No clear between-group differences were found in bradycardia, postoperative nausea and vomiting, PACU length of stay, or fentanyl consumption, and no documented clinically significant respiratory depression occurred in either group. Sensitivity analyses showed similar results for the primary outcome. Conclusion In patients with PAS in the PACU, dexmedetomidine was associated with a lower risk of treatment failure than meperidine, but a higher risk of hypotension. Dexmedetomidine may be an effective alternative when appropriate hemodynamic monitoring is available. Clinical trial registration Not applicable.
Kim et al. (Fri,) studied this question.
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