Background: Shivering is a frequent complication following spinal anesthesia, increasing oxygen consumption by up to 400% and posing risks to patients with limited cardiac reserve. Meperidine, a common treatment, is associated with adverse effects, necessitating safer alternatives like the α2-agonist Dexmedetomidine (DEX). This study aimed to compare the efficacy of intravenous DEX versus meperidine for the treatment of established post-spinal shivering, using saline as a placebo. Methods: This prospective, randomized, double-blind trial included 90 ASA I–II patients who developed Grade ≥2 shivering after spinal anesthesia, allocated into three equal groups (n=30 each): DEX, meperidine, and saline. The primary outcome was shivering cessation time, with secondary outcomes including response rate and adverse events. Results: DEX was superior to MEP in controlling shivering (P