Prophylactic Low-Dose Ketamine to Prevent Post
Anesthetic Shivering in Orthopedic Surgery:
A Randomized-Controlled Study
Suttasinee Petskul MD*, Chanatthee Kitsiripant MD*, Panthila Rujirojindakul MD*,
Amphan Chantarokorn MNS*, Arporn Jullabunyasit BNS*, Sarunyoo Thinchana BNS*
Affiliation :
* Department of Anesthesiology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
Objective : Post anesthetic shivering is one of the most common anesthesia complications. We compared the efficacy of
low-dose ketamine with normal saline in preventing post anesthetic shivering in orthopedic surgery.
Material and Method: The present study was a prospective, randomized, double-blind, controlled clinical trial involving
183 ASA I-III patients, aged 18 to 65 years whom underwent orthopedic surgery with general anesthesia. The patients were
randomly allocated to receive either ketamine 0.25 mg/kg (Group K, n = 91) or normal saline (Group P, n = 92) 20 minutes
before the completion of surgery. The tympanic temperature was measured before the induction of anesthesia, 30 minutes
after induction, and before administration of the study drugs. An investigator, blinded to the patients’ group affiliation,
graded post anesthetic shivering using the Crossley and Mahajan scale. The primary outcome was to compare incidence
of shivering on each group in recovery room. The secondary outcome was side effect of ketamine. Statistical analyses were
performed using program R version 3.1.0. A p-value of <0.05 was considered statistically significant.
Results : The patient characteristics of the two groups were similar, and the number of patients with observed shivering in
both groups was not statistically significantly different (Group K = 13 (14.28%) and Group P = 15 (16.30%), p = 0.42).
Furthermore, in both groups, no patient suffered from hallucination, and the other complications were not statistically
different.
Conclusion : At the recovery room, no significant efficacy difference between low-dose ketamine (0.25 mg/kg) and placebo
in the prevention of post operative shivering in patients who underwent orthopedic surgery was observed. Other factors
such as preload warm intravenous fluid, using active warming during surgery and control of the room temperature may
help prevent shivering.
Keywords : Low-dose ketamine, Prevention, Post anesthetic shivering, Orthopedic surgery, Side effect
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