Evaluation of the efficiencies of Dexamethasone, Ketamine, and Nefopam in prevention of post spinal shivering: A prospective, randomized, double-blind study

Background: One common and unwanted side effect of spinal anesthesia is shivering. To avoid this negative effect, various adjuvants have been utilized. In order to determine which medication was most successful and had the fewest adverse effects, we set out to compare the effectiveness of placebo, dexamethasone, ketamine, and nefopam in preventing postspinal shivering following lower abdomen and lower limb procedures.Methods: This prospective, randomized, double-blind, placebo-controlled trial was conducted at Zagazig University Hospitals on 140 adults scheduled for elective lower-body surgery under spinal anaesthesia. Patients were randomized to receive IV normal saline as placepo (control), Dexamethasone (D) 0.1 mg/kg, Ketamine (K) 0.2 mg/kg, or Nefopam (N) 0.15 mg/kg (all warmed to 37 °C) given immediately after the spinal block. Primary outcomes were shivering incidence, and severity, types and onset. Secondary outcomes included, haemodynamic changes, and the associated side effects.Results: The incidence and severity of postspinal shivering in dexamethasone, ketamine and nefopam groups were significantly lower than in control group and comparable between them. The onset time of postspinal shivering was significantly longer in D, K and N groups compared to C group with no statistically significant differences between the D, K and N groups. The associated side effects were minimal.Conclusion: Dexamethasone, ketamine and nefopam are efficient and safe in reducing the incidence and severity of postspinal shivering and no one is superior to the other.