Effect of Tramadol versus Ketamine on Post-Spinal Anesthesia Shivering in Lower Limb Surgeries

Background: Spinal anesthesia is beneficial, but shivering might affect patient care. Shivering prophylaxis using Tramadol and Ketamine needs additional research, particularly for lower limb procedures.Objectives: To compare Tramadol and Ketamine in reducing shivering after spinal anesthesia.Patients and methods: A spinal anesthetic clinical study in Egypt comprised 100 adult lower limb surgery patients. They were evenly divided into ketamine (K) and tramadol (T) groups. Severe shivering was treated with pethidine 25 mg IV depending on sedation. Intraoperatively, vital signs and side effects were observed.Results: Shivering was absent at 0-30 minutes in the Ketamine Group, but it increased subsequently (14% at 40 min, 20% at 50 min, 26% at 60 min). The Tramadol Group did not shiver at any time. The Ketamine Group had significant p-values for shivering over 40 minutes. RASS values were considerably lower in the Ketamine Group at 0, 10, and 20 min. RASS scores (30-60 min) were not significantly different. the Ketamine Group showed reduced SBP from 10 to 50 min and lower DBP at 10, 20, and 50 min, with no significant changes at 0, 30, 40, and 60 min. Continuously decreased heart rate in Ketamine Group from 10-60 min, with poorer oxygen saturation at 0 min but no significant difference at 10-60 min. Higher respiratory rate observed in Ketamine Group at 0 min and 10-30 min, but no significant changes at 40, 50, or 60 min.Conclusion: Tramadol was the most effective preventive drug, minimizing shivering during surgery and improving sedative, cardiovascular, and respiratory parameters.