Comparison of effect of intravenous tramadol and low dose ketamine in the attenuation of post spinal anaesthesia shivering following caesarean section: a double blinded randomised trial

Background: Intraoperative shivering is a common complication in patients undergoing caesarean section under spinal anaesthesia (SA). Various pharmacological agents including tramadol and ketamine have been used for the management of intraoperative shivering. Methods: This double-blinded randomized trial included a total of 72 patients scheduled for elective caesarean section under SA. Patients were randomly assigned to one of two groups: Group T (received tramadol 0.5 mg/kg intravenous) and group K (received ketamine 0.2 mg/kg intravenous). The primary outcome measure was the cessation of shivering after study drug administration. Secondary outcome measures included hemodynamic changes and adverse effects of study drugs. Results: The study compared the effects of intravenous tramadol and ketamine for treating intraoperative shivering during caesarean section under SA. Among 72 patients, tramadol 0.5 mg/kg was used in 36 patients and ketamine 0.2 mg/kg in 36 patients. The time to cessation of shivering was less with group T (2.59±0.54 s) than with group K (7.77±1.13 s). The recurrence rate of shivering with group T was significantly less (8.3%) as compared to group K (58.3%) with comparable hemodynamic parameters. No adverse effects were seen in both groups except for sedation among some in the ketamine group. Conclusions: Tramadol offers rapid onset and less recurrence rate of shivering with no sedation as a side effect when compared to ketamine. More studies of different dose ranges of the study drugs in different surgeries need to be conducted in order to cement its position as an efficient anti-shivering agent.