78 patients undergoing spine surgery for lumbar spinal stenosis were randomized to receive either nefopam (n=39) or saline control (n=39). The primary outcome of interest was the severity of dysesthesia on a Visual Analog Scale (VAS). Secondary outcomes of interest included estimated blood loss, intraoperative crystalloid, incidence of blood transfusion, operative time, anesthesia time, VAS back pain and surgical site pain, patient-controlled analgesia consumption, and the incidence of adverse events. Leg dysesthesia scores were significantly lower in the nefopam group at 12 and 24 hours compared to the saline control. Patient satisfaction was significantly higher in the nefopam group compared to the saline control. While nefopam can significantly lower the severity of leg dysesthesia immediately after surgery and improve patient satisfaction, it showed no benefit in improving intraoperative outcomes, pain, analgesic use, and the incidence of adverse events.