A Comparative Study Between Dexmedetomidine and Dexamethasone as an Intrathecal Adjuvant for Prevention of Perioperative Shivering in Cesarean Section

Perioperative shivering is a common complication following spinal anesthesia for cesarean section, affecting patient comfort and increasing metabolic demands. This prospective, randomized, double-blind study compared intrathecal dexmedetomidine versus dexamethasone as adjuvants to bupivacaine for preventing shivering. One hundred twenty parturients undergoing elective cesarean section were randomly allocated into three groups (n=40 each): Group B received 12.5mg hyperbaric bupivacaine alone, Group BD received bupivacaine plus 5μg dexmedetomidine, and Group BX received bupivacaine plus 4mg dexamethasone. The primary outcome was incidence of perioperative shivering. Secondary outcomes included shivering severity, onset and duration of block, hemodynamic parameters, core temperature changes, and neonatal outcomes. Shivering incidence was significantly lower in Group BD (15%) and Group BX (17.5%) compared to Group B (47.5%) (p<0.001). No significant difference existed between BD and BX groups (p=0.762). Both adjuvant groups showed prolonged sensory block duration (BD: 198±26min, BX: 176±22min vs B: 148±19min; p<0.001). Group BD had higher incidence of bradycardia (22.5% vs 7.5% in BX and 5% in B; p=0.034). Neonatal outcomes were comparable across groups. Both dexmedetomidine and dexamethasone effectively reduce perioperative shivering when used as intrathecal adjuvants, with dexmedetomidine providing longer analgesia but more bradycardia.