Efficacy of Intravenous Nefopam, Dexmedetomidine, and Meperidine in Preventing Postspinal Anesthesia Shivering in Adult Patients Undergoing Lower Abdominal and Lower Limb Surgeries: A Double-Blind Comparative Study.

BACKGROUND

A common and distressing consequence that may arise after spinal anesthesia (SA) is shivering. Research focuses on the role of intravenous (IV) nefopam, dexmedetomidine (DEX), and meperidine in averting shivering episodes in adult individuals receiving SA for surgical interventions on the lower abdomen or limbs.

METHODS

This prospective, randomized, controlled, double-blind trial involved 210 patients, aged 21-60 years, of both sexes, scheduled for abdominal or limb surgeries under SA. Patients were equally randomized into three groups: Groups N, D, and P received IV nefopam (0.2 mg/kg), DEX (0.5 μg/kg), and pethidine (0.5 mg/kg), respectively. The medications were infused over 20 min.

RESULTS

Heart rate and mean arterial pressure were significantly increased in Groups N and P as opposed to Group D (p < 0.05), with no considerable difference between Groups N and P. Oxygen saturation and core temperature remained similar across all groups at all measurement points. The incidence of shivering was significantly lower in Group N (6 [8.57%]) as opposed to Group P (19 [27.14%]) and Group D (39 [55.71%]) (p < 0.001). Shivering onset, grade, duration, frequency of rescue drug administration, and total rescue drug dosage were comparable among groups. However, sedation levels were significantly lower in Groups N (1 [1-2]) and P (2 [1-2]) as opposed to Group D (2 [1-2]) (p < 0.001 and p = 0.009), with no significant difference between Groups N and P (p = 0.06).

CONCLUSIONS

IV nefopam was more effective than DEX and pethidine in preventing shivering under SA, with fewer hemodynamic and sedative side effects.

TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT06627816.