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April 4, 20260 citationsOpen Access

Prophylactic Efficacy of Intravenous Nefopam Versus Ondansetron in Preventing Post-Spinal Shivering in Parturients Undergoing Elective Caesarean Section: A Double-Blind Randomised Controlled Trial

KMKefas Thomas Malau EIErdoo S. Isamade SNSamuel Nuhu

Key Points

The study aims to compare the efficacy and safety of intravenous nefopam versus ondansetron in preventing post-spinal shivering during elective caesarean sections.
Randomised controlled trial involving 96 ASA II parturients scheduled for elective caesarean section under spinal anaesthesia.
Participants were randomly allocated into three groups: nefopam, ondansetron, and placebo.
Medications were administered 15 minutes prior to spinal anaesthesia, and shivering was assessed using the Crossley and Mahajan scale.
Monitored for incidence, severity of shivering, side effects, and rescue medication requirements.
Both nefopam and ondansetron reduced the incidence of post-spinal shivering significantly compared to placebo (18.8% vs. 59.4%; p < 0.001).
Severe shivering only occurred in the placebo group (40.5%).
Need for rescue pethidine was significantly higher in the placebo group (37.5%), with none required in nefopam or ondansetron groups (p < 0.001).
Nausea was less frequent in the nefopam and ondansetron groups compared to placebo.

Abstract

Background: Post-spinal shivering (PSS) is a frequent complication of spinal anaesthesia during caesarean section, causing patient discomfort and potential physiological disturbances. Both nefopam and ondansetron possess anti-shivering properties; however, comparative evidence in obstetric patients is limited. The objective of this study is to compare the efficacy and safety of intravenous nefopam and ondansetron in preventing post-spinal shivering in women undergoing elective caesarean section under spinal anaesthesia. Methodology: This randomised controlled study included 96 ASA II parturients scheduled for elective caesarean section under spinal anaesthesia. Participants were randomly allocated into three groups (n = 32 each). Group N received intravenous nefopam (0.15 mg/kg), Group O received intravenous ondansetron (0.1 mg/kg), and Group P received 10 mL of normal saline as a placebo. The medications were administered 15 minutes before spinal anaesthesia. Patients were monitored for the incidence and severity of shivering using the Crossley and Mahajan scale. Side effects and the need for rescue medication (intravenous pethidine 0.5 mg/kg) were also recorded. Statistical significance was set at p < 0.05. Results: The incidence of PSS was significantly lower in Group N (18.8%) and Group O (18.8%) compared with Group P (59.4%) (p < 0.001). Severe shivering (grades 3–4) occurred only in the placebo group (40.5%). Consequently, the need for rescue pethidine was significantly higher in Group P (37.5%), while none of the patients in Groups N or O required it (p < 0.001). Postoperative nausea was less frequent in Group O (3.1%) and Group N (12.5%) compared with Group P (25%) (p < 0.05). Mild injection-site pain occurred only in Group N (9.4%). Conclusion: Intravenous nefopam and ondansetron are similarly effective in preventing post-spinal shivering and reducing rescue analgesia requirements during caesarean section under spinal anaesthesia. Ondansetron showed better antiemetic effect, while nefopam was associated with mild injection-site discomfort.

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