This prospective, randomized, controlled, double-blinded study is designed to evaluate the efficacy of nefopam compared to dexmedetomidine and meperidine for the prevention of postspinal anesthesia shivering while minimizing side effects.

Numerous clinical studies have demonstrated that nefopam effectively prevents and treats postoperative shivering after general anesthesia. For instance, a dose of 0.15 mg/kg nefopam is comparable in efficacy to 0.5 µg/kg dexmedetomidine for treating shivering after orthopedic or abdominal surgery. Additionally, 20 mg of nefopam is equally effective as 50 mg of meperidine in preventing shivering following certain neurosurgical procedures . Notably, patients administered nefopam experience less sedation and hypotension compared to those given dexmedetomidine. However, further research is needed to evaluate nefopam's effects on preventing shivering after neuraxial blockades.

Inclusion Criteria:

• Adult patients aged 21-60 undergoing elective lower abdominal, urological, gynecological, lower limb, orthopedic, or plastic surgeries under spinal anesthesia.

  • ASA physical status I and II.

Exclusion Criteria:

• • Known hypersensitivity to nefopam, dexmedetomidine, or pethidine.

  • Thyroid disorders, psychiatric disorders, severe diabetes, or autonomic neuropathies
  • Known history of substance or alcohol abuse
  • A history of convulsive disorders or severe neurological diseases
  • Severe cardiac, pulmonary, renal, or hepatic disease
  • Obstetric procedures and procedures requiring transfusion of blood and blood products.
  • A contraindication to spinal anesthesia, e.g., coagulation disorders, local or general infection, increased intracranial tension, and progressive neurological disorders.
  • Failed or partial spinal block.

double blind