Mitigating Post-Spinal Anesthesia Shivering by Exploring Intravenous Ketamine vs. Intravenous Tramadol and Comparison of the Optimal Dose of Ketamine: A Scoping Review of Cohort and Randomized Controlled Trials Studies

Siavash  Sangi; Mehrdad  Mesbah Kiaei; Maryam  Aligholizadeh; Alireza  Babajani; Parisa  Akbarpour; Elnaz  Jalalkamali; Zahra  Karimian

doi:10.18502/aacc.v11i3.18506

Siavash Sangi Anesthesia and Operating Room Department, Nursing and Midwifery Faculty, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Mehrdad Mesbah Kiaei Department of Anesthesiology and Pain Medicine, School of Medicine, Hasheminejad Kidney Center, Iran University of Medical Science, Tehran, Iran.
Maryam Aligholizadeh Anesthesia and Operating Room Department, Nursing and Midwifery Faculty, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Alireza Babajani Department of Anesthesia Technology, School of Allied Medical Sciences, Iran University of Medical Sciences, Tehran, Iran.
Parisa Akbarpour Department of Anesthesia Technology, School of Allied Medical Sciences, Iran University of Medical Sciences, Tehran, Iran.
Elnaz Jalalkamali Department of Anesthesia Technology, School of Allied Medical Sciences, Iran University of Medical Sciences, Tehran, Iran.
Zahra Karimian Anesthesia and Operating Room Department, Nursing and Midwifery Faculty, Shahid Beheshti University of Medical Sciences, Tehran, Iran

DOI: https://doi.org/10.18502/aacc.v11i3.18506

Keywords: Shivering; Ketamine; Tramadol; Spinal anesthesia; Scoping review

Abstract

Background: Shivering is prevalent in 65% of patients undergoing spinal anesthesia, resulting in adverse outcomes and increased healthcare expenses. Ketamine, an N-methyl-D-aspartate receptor antagonist, and tramadol exhibit analgesic properties, potentially mitigating post-spinal shivering. This scoping review aims to explore the existing literature on the intravenously administered ketamine and tramadol in reducing the incidence of shivering subsequent to spinal anesthesia.

Methods: This scoping review, conducted from April to June 2024, examined studies on intravenous ketamine and tramadol for shivering post-spinal anesthesia. Using MeSH terms, researchers searched Scopus, Web of Science, PubMed, Cochrane, Google Scholar, Iran SID, and Iran ISC. After excluding duplicates and irrelevant studies, six pertinent studies were included.

Results: The search strategy identified 1316 articles, with 1258 remaining after removing 58 duplicates. Title and abstract screening excluded 6 conference papers, 42 systematic reviews, 94 book chapters or animal studies, and 2 theses. A full-text review of 97 studies resulted in excluding 78 unrelated cases, 1 language discrepancy, and 11 without full-text availability. Ultimately, 6 studies (5 randomized controlled trials and 1 prospective cohort) from Iran, Pakistan, India, Egypt, and Ethiopia found ketamine more effective than tramadol in preventing shivering.

Conclusion: Ketamine is more effective than tramadol in preventing post-spinal anesthesia shivering, with fewer adverse effects like nausea, vomiting, and bradycardia. These findings support its use for shivering management. Future research should optimize dosing to reduce hallucinations, explore other side effects, and prioritize diverse study parameters and safety evaluations.