Background: Shivering is described as an involuntary, spontaneous, and repetitive muscular movement. Hypothermia is one of the frequent causes that lower the shivering threshold. Some pharmacologic agents like Nmethyl d-aspartate receptor antagonists, magnesium sulfate and opioid analgesics have been used for restriction of post-spinal anesthesia shivering. Aim of the Work: to compare the effectiveness of low-dose intravenous ketamine (0.2 mg/kg) with that of (0.5 mg/kg) intravenous tramadol for the inhibition of post-spinal anesthesia shivering in patients who underwent elective surgeries. Patient and Methods: This is a prospective, randomized, double-blind, placebo-controlled study that was approved by the Mustasharak Hospital Ethical Review Committee, KSA. A total of 150 patients (ASA) I and II aged 21-60 years, who were prepared for surgery under subarachnoid anesthesia from March 2017 to December 2018 were included. After Subarachnoid anesthesia, patients were randomized using the open envelope technique to one of the following three groups: (K) group = ketamine (0.2 mg/kg intravenously), (T) group = tramadol (0.5 mg/kg) and (S) group = saline (5 mL normal saline). The tympanic membrane and core temperatures were documented every 5 minutes until the end of the surgery. Shivering scores were reported every 5 minutes and every 10 minutes postoperatively for 60 minutes. Hemodynamic readings were reported every 5 minutes intraoperatively and every 10 minutes postoperatively for 60 minutes. Adverse events were reported. The level of sedation was valued according to a five-point scale.Results: There was a significant difference among the groups (tramadol vs placebo and ketamine vs placebo p However, there was no significant difference between tramadol and ketamine groups (p The incidence of grade 3 shivering showed a statistically significant difference (p in the normal saline group as compared to the tramadol group and the ketamine group. The time taken from the administration of the study drugs to the onset of shivering was statistically different among the groups (p all groups, there was a significant decrease in tympanic temperature after subarachnoid anesthesia with respect to baseline values. Tympanic and core temperature changes over time in each group were statistically significant (p 2). Conclusion:The prophylactic administration of low-dose IV ketamine (0.2 mg/kg) or 0.5 mg/kg IV tramadol is effective in reducing the incidence and intensity of shivering in patients having surgery under subarachnoid anesthesia with the priority to tramadol.

Background: Magnesium, a physiological antagonist of calcium and N-methyl-Daspartate receptors (NMDA), has a role in the prevention of pain in patients undergoing different surgeries. Patients and Methods: This prospective randomized double-blinded controlled study was conducted on 60 patients undergoing lower extremities arthroscopic surgery. Spinal anesthesia was given to all patients and epidural catheters inserted at L4/ L5 or L3/ L4 inter-space, prior to surgery for postoperative pain management. Postoperatively, the patients were randomly allocated into three equal groups. Group I (Control S group; n 20 patients) patients received epidural saline at a rate of 1ml/h for 24 hours. Group II (MI; n 20 patients) patients received epidural 50mg magnesium sulfate in 5ml volume of normal saline as a bolus dose followed by continuous epidural infusion of 100mg at a total of 24ml volume for 24 hours at a rate of 4mg/h. Group III (M II; contain 20 patients) patients received epidural 50mg magnesium sulfate in 5ml volume of normal saline as a bolus dose followed by continuous epidural infusion of 500mg at a total 24ml volume for 24 hours at a rate of 20 mg/h. All patients will be provided with a syringe pump device and the primary setting of background infusion of fentanyl 3 mic/ml at a rate of 10 ml/h via an epidural catheter. The visual analog score, vital signs, time of the first request for rescue analgesia, motor block, need for supplemental analgesic and adverse effects were recorded in the postoperative period. Results VAS scores were significantly lower in both MI and MII groups as compared with the control group at the 1 st hour and the 2 nd hour of the postoperative course. Conclusion The addition of epidural magnesium sulfate for postoperative epidural analgesia provided a pronounced significant reduction in postoperative rescue analgesia with no significant difference between the two magnesium doses and minimal side effects.

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Available online at Journal Website https://ijma.journals.ekb.eg/ Main subject [Anesthesia and Intensive Care] *