European Journal of Cardiovascular Medicine

Background: Shivering frequently occurs in cesarean section (CS) under spinal anesthesia (SA), resulting in several complications. The objective of this study was to compare the efficacy of intravenous tramadol and ketamine with placebo in the treatment of intraoperative shivering in patients undergoing cesarean section under spinal anesthesia. Methods: This randomized, double-blind clinical trial was conducted at a tertiary care hospital in Uttar Pradesh. A total of 120 patients scheduled for elective cesarean section under spinal anesthesia were randomly allocated into three groups: Group T (tramadol), Group K (ketamine), and Group P (placebo). Patients in Group T received intravenous tramadol 1 mg/kg, Group K received intravenous ketamine 0.5 mg/kg, and Group P received normal saline as a placebo. The occurrence and severity of shivering were assessed using a standardized shivering scale. Hemodynamic parameters, adverse effects, and patient satisfaction were also recorded. Results: The occurrence of intraoperative shivering was significantly lower in Group T (15%) and Group K (20%) compared to Group P (70%) (p < 0.001). Both tramadol and ketamine effectively reduced the severity of shivering compared to placebo (p < 0.001). Hemodynamic parameters remained stable in all groups. Adverse effects, such as nausea and sedation, were more prevalent in the tramadol group compared to the ketamine and placebo groups. Patient satisfaction was higher in Group T and Group K compared to Group P. Conclusion: Intravenous tramadol and ketamine are effective in reducing the occurrence and severity of intraoperative shivering in patients undergoing cesarean section under spinal anesthesia. However, tramadol is associated with a higher incidence of adverse effects compared to ketamine. Therefore, ketamine may be considered as a safer alternative in the management of intraoperative shivering during cesarean section under spinal anesthesia.