Main Article Content

Muhammad Javed khan
Saira khan
Rumman Khan


Orthopedic patients Prophylactic, ketamine, Pre-operative shivering, Spinal anesthesia


Background: Shivering is observed in almost 35 -85 % of the cases after spinal anesthesia. Usually use of pharmaceuticals and physical techniques like external heating is carried to prevent peri-operative hypothermia and shivering. 

Objective: To evaluate the efficacy of low dose ketamine in avoiding peri-operative shivering in orthopedic patients taking spinal anesthesia. 

Methodology: This was prospective study conducted at the Anaesthesia Department Khyber Teaching Hospital Peshawar. The study was conducted for a period of six months from January 2023 to June 2023. Totally, 100 patients were incorporated. Group 1 patients (n=50) were given low dose of ketamine (0.2 mg/kg iv) after spinal anesthesia while group 2 patients (n=50) were given 5ml of saline after spinal anesthesia. Axillary/frontal temperature was measured at 0, 15 and 30 minutes after spinal anesthesia. 

Results: In group 1, shivering was observed in 2 (4%), 2 (4%) and 4 (8%) patients after 0, 15 and 30 minutes respectively while in group 2, shivering was observed in 0, 10 (20%) and 16 (32%) patients after 0, 15 and 30 minutes respectively (p=0.006). In group 1, rescue maneuver was used in 7 (14%) patients while group 2 rescue maneuver was used in 14 (28%) patients. This difference was statistically significant (p=0.005) 

Conclusion: The study concludes that prophylactic Low dosage of ketamine is effective in preventing shivering during spinal anesthesia in orthopedic patients. 

Abstract 99 | PDF Downloads 18


1. De Witte J, Sessler DI. Perioperative shivering: physiology and pharmacology. The Journal of the American Society of Anesthesiologists. 2002;96(2):467-84.
2. Joris J, Ozaki M, Sessler DI, Hardy AF, Lamy M, McGuire J, et al. Epidural anesthesia impairs both central and peripheral thermoregulatory control during general anesthesia. The Journal of the American Society of Anesthesiologists. 1994;80(2):268-77.
3. Webb PJ, PJ W, JAMES FI. Shivering during epidural analgesia in women in labor. 1981.
4. Yu SC, Ngan Kee W, Kwan A. Addition of meperidine to bupivacaine for spinal anaesthesia for Caesarean section. Br J Anaesth. 2002;88(3):379-83.
5. Kranke P, Eberhart LH, Roewer N, Tramèr MR. Single-dose parenteral pharmacological interventions for the prevention of postoperative shivering: a quantitative systematic review of randomized controlled trials. Anesth Analg. 2004;99(3):718-27.
6. Glosten B, Sessler DI, Faure E, Karl L, Thisted RA. Central temperature changes are poorly perceived during epidural anesthesia. Anesthesiology. 1992;77(1):10-6.
7. Matsukawa T, Sessler DI, Sessler AM, Schroeder M, Ozaki M, Kurz A, et al. Heat flow and distribution during induction of general anesthesia. The Journal of the American Society of Anesthesiologists. 1995;82(3):662-73.
8. Kurz A, Sessler DI, Schroeder M, Kurz M. Thermoregulatory response thresholds during spinal anesthesia. Anesth Analg. 1993;77(4):721-6.
9. Ozaki M, Kurz A, Sessler DI, Lenhardt R, Schroeder M, Moayeri A, et al. Thermoregulatory thresholds during epidural and spinal anesthesia. Anesthesiology. 1994;81(2):282-8.
10. Ostheimer GW, Datta S. Observations in the postpartum recovery room after various local anesthetic techniques. Reg Anesth Pain Med. 1981;6(1):13-7.
11. Honarmand A, Safavi M. Comparison of prophylactic use of midazolam, ketamine, and ketamine plus midazolam for prevention of shivering during regional anaesthesia: a randomized double-blind placebo controlled trial. Br J Anaesth. 2008;101(4):557-62.
12. Kose EA, Dal D, Akinci SB, Saricaoglu F, Aypar U. The efficacy of ketamine for the treatment of postoperative shivering. Anesth Analg. 2008;106(1):120-2.
13. Ikeda T, Kazama T, Sessler DI, Toriyama S, Niwa K, Shimada C, et al. Induction of anesthesia with ketamine reduces the magnitude of redistribution hypothermia. Anesth Analg. 2001;93(4):934-8.
14. Sagir O, Gulhas N, Toprak H, Yucel A, Begec Z, Ersoy O. Control of shivering during regional anaesthesia: prophylactic ketamine and granisetron. Acta Anaesthesiol Scand. 2007;51(1):44-9.
15. Choi HA, Ko S-B, Presciutti M, Fernandez L, Carpenter AM, Lesch C, et al. Prevention of shivering during therapeutic temperature modulation: the Columbia anti-shivering protocol. Neurocrit Care. 2011;14(3):389-94.
16. Alfonsi P. Postanaesthetic shivering. Epidemiology, pathophysiology and approaches to prevention and management. Minerva Anestesiol. 2003;69(5):438-42.
17. Mittal G, Gupta K, Katyal S, Kaushal S. Randomised double-blind comparative study of dexmedetomidine and tramadol for post-spinal anaesthesia shivering. Indian J Anaesth. 2014;58(3):257.
18. Ameta N, Jacob M, Hasnain S, Ramesh G. Comparison of prophylactic use of ketamine, tramadol, and dexmedetomidine for prevention of shivering after spinal anesthesia. J Anaesthesiol Clin Pharmacol. 2018;34(3):352.
19. Bozgeyik S, Mizrak A, Kılıç E, Yendi F, Ugur BK. The effects of preemptive tramadol and dexmedetomidine on shivering during arthroscopy. Saudi J Anaesth. 2014;8(2):238.
20. Shakya B, Chaturvedi A, Sah B. Prophylactic low dose ketamine and ondansetron for prevention of shivering during spinal anaesthesia. J Anaesthesiol Clin Pharmacol. 2010;26(4):465.
21. Lema GF, Gebremedhn EG, Gebregzi AH, Desta YT, Kassa AA. Efficacy of intravenous tramadol and low-dose ketamine in the prevention of post-spinal anesthesia shivering following cesarean section: a double-blinded, randomized control trial. International journal of women's health. 2017;9:681.
22. Kose E, Honca M, Dal D, Akinci S, Aypar U. Prophylactic ketamine to prevent shivering in parturients undergoing Cesarean delivery during spinal anesthesia. J Clin Anesth. 2013;25(4):275-80.
23. Canini F, Simler N, Bourdon L. MK801 impairs thermoregulation in the heat. Can J Physiol Pharmacol. 2002;80(3):226-32.
24. Clements J, Nimmo W. Pharmacokinetics and analgesic effect of ketamine in man. BJA: British Journal of Anaesthesia. 1981;53(1):27-30.
25. Sharma D, Thakur J. Ketamine and shivering. Anaesthesia. 1990;45(3):252-3.