Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 0 0 2026 02 25 1521 1521 Milad Masaeli Water and Electrolyte Research Center, Isfahan University of Medical Sciences, Isfahan, Iran. & Department of Anesthesiology, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran. & Anesthesiology and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran. Mohammadreza Habibzadeh Water and Electrolyte Research Center, Isfahan University of Medical Sciences, Isfahan, Iran. & Department of Anesthesiology, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran. Setayesh Sindarreh Epidemiology and Biostatistics Department, Health School, Isfahan University of Medical Sciences, Isfahan, Iran. & Cancer Prevention Research Center, Isfahan University of Medical Sciences, Isfahan, Iran. Kazhal Mirzaee Tabar Student Research Committee, Tehran University of Medical Sciences, Tehran, Iran. Zahra Safari Student Research Committee, Isfahan University of Medical Sciences, Isfahan, Iran. Tayyebe Faraji Department of Pediatrics, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran. 2025 12 11 2025 12 27 Background: Post spinal anesthesia shivering (PSAS) remains a common and distressing complication during cesarean delivery, with potential metabolic and cardiovascular consequences for parturients. Although several pharmacological strategies have been proposed for its prevention, the optimal prophylactic regimen with minimal adverse effects is still under investigation. This study aimed to evaluate the effectiveness of dexamethasone, alone or in combination with meperidine, in preventing post spinal anesthesia shivering in patients undergoing cesarean section. Methods: In this randomized double-blind trial, 144 parturients undergoing cesarean section under spinal anesthesia were assigned to receive intravenous dexamethasone 4 mg (n=50), dexamethasone 6 mg (n=43), or saline placebo (n=51). Shivering was graded on a validated four-point scale. The primary outcome was shivering intensity, while shivering incidence, hemodynamic parameters, adverse events, pethidine requirements, and patient satisfaction were considered secondary outcomes. Sample size was calculated based on a prior effect size with a power of 80% and a significance level of 0.05. Results: Shivering incidence was 70% in the dexamethasone 4 mg group, 53.5% in the 6 mg group, and 49% in controls (DEXA-4 vs control: OR=2.41, 95% CI: 1.10–5.31; DEXA-6 vs control: OR=1.20, 95% CI: 0.55–2.63) (p=0.083). Shivering intensity was significantly lower in both dexamethasone groups compared with the control (p=0.001). Time to shivering onset and need for pethidine were also reduced in the dexamethasone groups (p=0.010 and p=0.017, respectively). Hemodynamic profiles and adverse event rates did not differ significantly among groups. Conclusion: The findings suggest that dexamethasone, particularly when used as an adjunct to low dose meperidine, may provide effective prophylaxis against PSAS while potentially reducing opioid related side effects. This approach represents a practical and well tolerated strategy for shivering prevention during cesarean delivery under spinal anesthesia. https://aacc.tums.ac.ir/index.php/aacc/article/view/1521