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Abstract
Background: Post-spinal anesthesia shivering (PAS) is a common and distressing complication during cesarean section, leading to increased oxygen consumption, sympathetic stimulation, and patient discomfort. Various pharmacological agents, including ketamine and tramadol, have been used for prophylaxis, but comparative data remain limited.
Objective: To compare the effectiveness of low-dose ketamine versus tramadol in preventing post-spinal anesthesia shivering in elective cesarean section.
Methods: This quasi-experimental study was conducted at Northwest General Hospital, Peshawar, from September 2024 to March 2025. Ninety-two term pregnant women (ASA I–II) scheduled for elective cesarean section under spinal anesthesia were enrolled and allocated into two groups: Group A received ketamine 0.2 mg/kg IV, and Group B received tramadol 0.5 mg/kg IV immediately after spinal anesthesia. Shivering was assessed using the Crossley and Mahajan scale intraoperatively and for 45 minutes postoperatively. Rescue pethidine (25 mg IV) was administered for persistent shivering. Adverse effects and hemodynamic parameters were recorded.
Results: Shivering occurred in 23.9% of patients in the ketamine group versus 39.1% in the tramadol group (p = 0.04). Moderate-to-severe shivering was more frequent in the tramadol group. Rescue pethidine was required in 6.5% of ketamine patients compared to 15.2% in the tramadol group. Nausea and vomiting were higher in the tramadol group, while mild sedation was more common with ketamine. No serious adverse events were observed.
Conclusion: Low-dose ketamine is more effective and better tolerated than tramadol in preventing post-spinal anesthesia shivering during elective cesarean section.