COMPARISON OF PROPHYLACTIC USE OF KETAMINE AND TRAMADOL FOR THE PREVENTION OF SHIVERING DURING SPINAL ANESTHESIA
DOI:
https://doi.org/10.71000/6h715146Keywords:
Anesthesia, , Tramadol, Drug Therapy, Ketamine, Perioperative Care, Postoperative Complications, Spinal AnesthesiaAbstract
Background: Post-spinal anesthesia shivering is a frequent and distressing complication that may impair postoperative recovery, increase oxygen consumption, and induce cardiovascular instability. It affects up to 70% of patients receiving regional anesthesia, particularly during abdominal or lower limb surgeries. Effective pharmacologic management is essential to reduce its physiological burden and enhance patient comfort. Ketamine and tramadol have both demonstrated anti-shivering properties through distinct mechanisms, yet their comparative effectiveness remains under-explored.
Objective: To compare the prophylactic efficacy and safety of intravenous ketamine and tramadol in preventing shivering during spinal anesthesia.
Methods: This randomized comparative study included 110 adult patients (aged 18–60 years) undergoing elective lower abdominal or lower limb surgery under spinal anesthesia. Patients were randomly assigned to receive either intravenous ketamine 0.25 mg/kg (n=55) or tramadol 0.5 mg/kg (n=55) immediately after spinal block with 3 mL of 0.5% hyperbaric bupivacaine. Shivering intensity was recorded using a validated 5-point scale at baseline, and at 5, 10, 15, and 20 minutes post-administration. Core temperature was monitored tympanically. Adverse effects such as hypotension, hallucinations, and gastrointestinal disturbances were documented.
Results: At 20 minutes, 81.8% of ketamine patients and 89.1% of tramadol patients exhibited no shivering (score 0). However, moderate to severe shivering (scores 5–8) was more common in the tramadol group (25.5%) than in the ketamine group (1.8%). At 10 minutes, 65.5% of ketamine patients had no shivering compared to 78.2% in the tramadol group. Ketamine showed superior control during early intraoperative periods with fewer adverse events.
Conclusion: Both ketamine and tramadol effectively reduced intraoperative shivering during spinal anesthesia. Ketamine offered more consistent control with fewer moderate to severe cases, suggesting it as the preferable agent, especially in high-risk patients.
References
Koukoulithras I, Alkhazi A, Gkampenis A, Stamouli A, Plexousakis M, Drousia G, et al. A Systematic Review of the Interventions for Management of Pain in Patients After Spinal Cord Injury. Cureus. 2023;15(7):e42657.
Preuss CV, Kalava A, King KC. Prescription of Controlled Substances: Benefits and Risks. StatPearls. Treasure Island (FL): StatPearls Publishing
Copyright © 2025, StatPearls Publishing LLC.; 2025.
Lai HC, Kuo YW, Huang YH, Chan SM, Cheng KI, Wu ZF. Pancreatic Cancer and Microenvironments: Implications of Anesthesia. Cancers (Basel). 2022;14(11).
Rusbridge C. Neuropathic pain in cats: Mechanisms and multimodal management. J Feline Med Surg. 2024;26(5):1098612x241246518.
Farokhzad B, Sabiza S, Razi Jalali M, Baniadam A. Intraperitoneal administration of lidocaine or tramadol alone or in combination on postoperative pain after ovariohysterectomy in dogs. Vet Med Sci. 2021;7(3):634-41.
Boroujerdi R, Paul R. Graphene-Based Electrochemical Sensors for Psychoactive Drugs. Nanomaterials (Basel). 2022;12(13).
Perrot S. Fibromyalgia: do I tackle you with pharmacological treatments? Pain Rep. 2025;10(1):e1222.
Uscategui RA, Barros FF, Almeida VT, Kawanami AE, Feliciano MA, Vicente WR. Evaluation of chemical restraint, isoflurane anesthesia and methadone or tramadol as preventive analgesia in spotted pacas (Cuniculus paca) subjected to laparoscopy. Vet Anaesth Analg. 2021;48(1):82-91.
Mahdi AH, Kahloul M, Mohammed MJ, Mohammed AK. Effects of Ketamine and Tramadol As Adjuvants to Bupivacaine in Spinal Anesthesia for Unilateral Open Ovarian Cystectomy: A Randomized Controlled Trial. Cureus. 2024;16(2):e54776.
Fenta E, Kibret S, Hunie M, Tamire T, Fentie Y, Seid S, et al. The effects of intravenous tramadol vs. intravenous ketamine in the prevention of shivering during spinal anesthesia: A meta-analysis of randomized controlled trials. Front Med (Lausanne). 2022;9:1011953.
Souza T, Dos Anjos N, Kersul I, Filho EM, Nunes T, Barbosa V. Effects of dexmedetomidine or tramadol continuous rate infusions on the propofol requirements and cardiorespiratory variables in propofol-ketamine-midazolam anaesthetised cats. Vet Med (Praha). 2022;67(4):199-205.
Li S, Li P, Wang R, Li H. Different interventions for preventing postoperative catheter-related bladder discomfort: a systematic review and meta-analysis. Eur J Clin Pharmacol. 2022;78(6):897-906.
Wang L, Guo Y, Tian J. The comparison of ketamine with tramadol for postoperative pain relief on children following adenotonsillectomy or tonsillectomy: A meta-analysis of randomized controlled trials. Medicine (Baltimore). 2021;100(14):e22541.
Naghipour B, Pouraghaei M, Tabatabaey A, Arjmand A, Faridaalaee G. Comparison of Ketamine and Tramadol in Management of Acute Pain; a Systematic Review. Arch Acad Emerg Med. 2020;8(1):e68.
Deshpande AA, Hemavathy OR, Krishnan S, Ahmed R. Comparison of effect of intra socket ketamine and tramadol on postoperative pain after mandibular third molar surgery. Natl J Maxillofac Surg. 2022;13(1):95-8.
Kunze PE, Molina CV, Lima DM, Arias-Lugo MA, Pissinatti A, Moreira SB, et al. Comparison between three dosages of intramuscular alfaxalone and a ketamine-dexmedetomidine-midazolam-tramadol combination in golden-headed lion tamarins (Leontopithecus chrysomelas). Vet Anaesth Analg. 2021;48(5):697-706.
Mohammadzadeh Jouryabi A, Sharami SH, Mansour Ghanaie M, Sedighinejad A, Imantalab V, Rafiee Sorouri Z, et al. Comparing the Effects of Low Dose of Ketamine, Tramadol, and Ondansetron in Prevention of Post Spinal Anesthesia Shivering in Cesarean Section. Anesth Pain Med. 2021;11(4):e116429.
Maroufi SS, Kiaei MM, Sangi S, Aligholizadeh M, Abbasi M, Moradimajd P, et al. Comparative Efficacy of Intravenous Ketamine and Tramadol in Reducing Postspinal Anesthesia Shivering in Urological Surgeries: A Triple-blind Randomized Clinical Trial. J Res Pharm Pract. 2024;13(3):92-9.
Fenta E, Kibret S, Hunie M, Tamire T, Fentie Y, Seid S, et al. The effects of intravenous tramadol vs. intravenous ketamine in the prevention of shivering during spinal anesthesia: A meta-analysis of randomized controlled trials. Front Med (Lausanne). 2022; 9:1011953.
Thangavelu R, George SK, Kandasamy R. Prophylactic low dose ketamine infusion for prevention of shivering during spinal anesthesia: A randomized double blind clinical trial. J Anaesthesiol Clin Pharmacol. 2020;36(4):506-10.
Seyam SH. Prevention of post-spinal anesthesia shivering: Low dose ketamine vs tramadol. Al-Azhar Int Med J. 2020;1(4):108-15.
Kumar RA, Ammu S. Comparing the efficacy of tramadol, ketamine and dexmedetomidine in the prevention of intraoperative shivering in patients undergoing surgery under subarachnoid blockade. Indian J Clin Anaesth. 2021;8(3):446-51.
Waheed A, Raza S, Saleh M, Zia HA, Jan B, Umair HM. The Effect of Ketamine Versus Tramadol on Prophylactic Post-Spinal Shivering in Those Patients Undergoing Orthopedic Surgery. Pakistan Journal of Medical & Health Sciences. 2023;17(01):648-.
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Copyright (c) 2025 Zahoor Rahman, Chanda Naseem, Shah Faisal, Fazal Wadood (Author)
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