scholarly journals Intraperitoneal Hydrocortisone plus Bupivacaine versus Bupivacaine alone for Pain Relief after Laparoscopic Cholecystectomy

2016 ◽  
Vol 3 (2) ◽  
pp. 41 ◽  
Author(s):  
Mahesh Sharma ◽  
Kalpana Kharbuja ◽  
Nil Raj Sharma
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Pain Relief ◽  
Normal Saline ◽  
Randomized Study ◽  
Saline Group ◽  
Normal Saline Group ◽  
Analgesic Requirement ◽  
Number Of Patients ◽  
Group A ◽  
Group B

Introduction: Laparoscopic cholecystectomy has been the gold standard in the treatment of gallstones since last decades. Beside several benefits of laparoscopic cholecystectomy compared with open surgery, postoperative pain is still a frequent melancholy.  Hence, pain management is utmost regarding patients' comfort. The main objective of the study was to compare the effect of intraperitoneal hydrocortisone plus bupivacaine with bupivacaine alone on pain relief following laparoscopic cholecystectomy.   Methods: A randomized study was conducted from December 2015 to August 2015 that included 100 patients aged 20 to 60 years of both genders who were found to have symptomatic gallstones and were scheduled for elective laparoscopic cholecystectomy at Lumbini Medical College. Patients randomly received 100 mg hydrocortisone plus 100 mg bupivacaine in 200 ml normal saline (group A) or 100 mg bupivacaine in 200 ml normal saline (group B) into the peritoneum. Post-operative abdominal and shoulder pain were evaluated using Visual Analog Score (VAS). The patients were also followed up for postoperative analgesic requirements, and recovery variables. Data were collected, tabulated and analyzed statistically using SPSS version 19.   Results: Total number of patients in this study were 100. Age and gender among both groups were comparable. VAS scores for pain was significantly lower for group A as compared to group B at 0, 2, 4, 6, 12, and 24 hours. Time of oral intake in hrs for liquids and solids was statistically significant in Group A compared to Group B. Rescue analgesic requirement was also significantly low in Group A compared to Group B. Hospital stay in both group were comparable.   Conclusion: Combination of hydrocortisone plus bupivacaine can relieve pain after laparoscopic cholecystectomy better compared to bupivacaine alone when administered intraperitoneally.

The Effect of Prophylactic Ephedrine on Systemic Hypotension Caused by Induction of Anaesthesia with Propofol and Sufentanil in Elderly Hypertensive Patients: A Prospective Randomized, Double-blind Placebo-controlled Clinical Trial

2020 ◽  
Keyword(s):  
Blood Pressure ◽  
General Anesthesia ◽  
Normal Saline ◽  
Saline Group ◽  
Normal Saline Group ◽  
Hypertensive Patients ◽  
Group A ◽  
Elderly Hypertensive ◽  
Elderly Hypertensive Patients ◽  
Group B

Objective: To study the effectiveness of prophylactic ephedrine to prevent hypotension caused by induction of anesthesia with propofol and sufentanil in elderly hypertensive patients. Methodology: 70 elderly ASA grade II-III hypertensive patients undergoing elective general anesthesia were randomized into two groups to receive either intravenous ephedrine,100 ug/kg in 5ml normal saline (Group B), or an equal volume of normal saline (Group A) before induction. Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP) and Heart Rate (HR) were recorded at T0 (after entry to the operating room), T1 (1 min after induction), T2 (2 min after induction), T3 ( 3 min after induction), T4 (4 min after induction), T5 (when intubated), T6 (2 min after intubation), and T7 (at the start of the procedure), as well as the incidence of hypotension and bradycardia. Results: SBP, DBP and HR were not significantly different at T0 and were significantly different at T1 to T7 after anesthesia induction. There were statistically significant effect on hypotension and bradycardia between the two groups and group B have a lower risk of hypotension and bradycardia relative to group A. SBP and DBP decreased significantly after induction in both groups. HR decreased significantly in group A while increased in group B. Conclusion: Ephedrine pretreatment can minimize hypotension and bradycardia caused by propofol and sufentanil during the induction of general anesthesia in elderly patients with hypertension.

scholarly journals Comparison of intraincisional and intraperitoneal infiltration of local anaesthetic in laparoscopic cholecystectomy to control early postoperative pain.

2021 ◽  
Vol 28 (02) ◽  
pp. 192-196
Author(s):  
Nadia Bano ◽  
Nazim Hayat ◽  
Saira Saleem ◽  
Farhan Javaid ◽  
Ayesha Rehman ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Postoperative Pain ◽  
Pain Relief ◽  
Local Anaesthetic ◽  
Early Postoperative Period ◽  
P Value ◽  
Analgesic Requirement ◽  
Rescue Analgesia ◽  
Group A ◽  
Group B

Objective: To compare the effects of intraincisional and intraperitoneal infiltration of local anaesthetic to relieve early postoperative pain in laparoscopic cholecystectomy. Study Design: Randomized Control Trial. Setting: Department of Anaesthesia and Surgery, Madinah Teaching Hospital Faisalabad. Period: July 2017 to March 2018. Material & Methods: A sample of 100 patients with American Society of Anaesthesiologists Physical status (ASA) I and II, undergoing laparoscopic cholecystectomy were selected using simple random sampling technique. Patients were randomly assigned into groups A and B. Group A patients received intraperitoneal infiltration of 20 ml solution of 0.25% bupivacaine and group B patients received intraincisional infiltration of 20 ml solution of 0.25% bupivacaine. Results:  Demographic characteristics were not significantly different in both groups. Our study showed that Group A patients had better pain relief as compared to group B patients. Visual analogue score (VAS) for pain relief at 0, 3,6,12 and 24 hours was statistically different in both groups. The requirement of rescue analgesia between group A and B was found to be12% and 38% which is statically significant (p value 0.003). Conclusion: intraperitoneal infiltration of Bupivacaine offers better postoperative pain relief after laparoscopic cholecystectomy and is associated with less analgesic requirement in early postoperative period.

scholarly journals Preoperative Intravenous Paracetamol Reduces Postoperative Opioid Consumption in Laparoscopic CholecystectomyPatients - An Experience of A Tertiary Specialized Hospital in Bangladesh

2020 ◽  
Vol 5 (2) ◽  
pp. 246
Author(s):  
Sultan Reza ◽  
Tamanna Habib ◽  
Mohammad Ifta Khiarul Hasan ◽  
Anik Roy Chowdhury ◽  
Saifuddin Mohammad Mamun ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Pain Score ◽  
Normal Saline ◽  
Skin Incision ◽  
Opioid Consumption ◽  
Analgesic Requirement ◽  
Intravenous Paracetamol ◽  
Group A ◽  
The Mean ◽  
Group B

Background: Afferent blockade of nociceptive (pain) impulses by paracetamol can bein effect throughout intraoperative and postoperative period.Objective: To see the effect of preoperative intravenous paracetamol administration in laparoscopic cholecystectomy patients.Methods: This single blind, randomized, prospective, case-control studywas conducted in Department of Anesthesiology, Square Hospitals, Dhaka, Bangladesh, between July and December of 2014. A total of 60 adult patients scheduled for laparoscopic cholecystectomy under general anesthesiawere enrolled in this study. Patients were randomly allocated equally into two groups – A (cases) and B (controls), through a computerized random table, with 30 patients in each group. Patients of group A (cases) received intravenous paracetamol 10mg/kg (in 100ml of normal saline) 10 minutes before skin incision, while group B (controls) received only 100 ml of normal saline 10 minutes before skin incision. Postoperative pain score, duration of demand of first analgesic after operation and amount of opioid requirement were noted down.Results: The mean age of group A was 39.3±4.3 years and in group B 37.4±4.4 years (P>0.05).The mean pain score after 1 hour of operation was 4.4±0.3 in group A and 4.7±0.3 in group B, which reduced to 2.7±0.3 and 2.9±0.2 after 6 hours, then 1.7±0.2 and 1.8±0.2 after 12 hours and 1.0±0.1 and 1.1±0.2 after 24 hours respectively (P<0.05). Early demand of postoperative analgesic within 10 minutes was observed much less in the group A, compared to group B (P<0.001). The mean amount of pethidine required at 1st hour was 34.8±5.4 mg and 36.6±5.0 mg in group A and group B respectively, which increased up to 77.3±10.7 mg and 92.1±8.5 mg respectively at 6th hour. However, the amount steeply decreased at 12th hour to 29.4±5.4 mg and 28.1±4.7 mg respectively (P<0.001). The total amount of pethidine needed was significantly lower in the group A than that of group B (126.8±14.4 vs. 139.6±9.5 mg; P<0.05).Conclusion: Preoperative load of intravenous paracetamol increases the duration of further analgesic requirement as well as reduces postoperative opioid consumption in laparoscopic cholecystectomy patients.International Journal of Human and Health Sciences Vol. 05 No. 02 April’21 Page: 246-250

scholarly journals A comparative study of dexmedetomidine versus clonidine in epidural anaesthesia to assess the level of sedation in patients undergoing lower abdominal and lower limb surgery

2018 ◽  
Vol 6 (5) ◽  
pp. 1666
Author(s):  
Vinay Pathak ◽  
B. B. Kushwaha ◽  
Girish Chandra ◽  
V. K. Bhatia ◽  
Akash Gupta ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Normal Saline ◽  
Lower Limb ◽  
Saline Group ◽  
Hemodynamic Parameters ◽  
Normal Saline Group ◽  
Time Intervals ◽  
Group A ◽  
Group B

Background: To compare study of dexmedetomidine versus clonidine in epidural anesthesia to assess the level of sedation in patients undergoing lower abdominal and lower limb surgery.Methods: This was a comparative study conducted on admitted ASA grade I and II patients undergoing lower abdominal and lower limb surgeries. The patients were divided into three groups of 30 patients each, according to the epidural medication they received:-Group A-received 15ml of bupivacaine (0.5%) and dexmedetomidine (1.0µg/kg body weight) in 1ml of normal saline; Group B-received 15ml of bupivacaine (0.5%) and clonidine (2.0µg/kg body weight) in 1ml of normal saline; Group C-received 15ml of bupivacaine (0.5%) with 1ml of normal saline. The heart rate, blood pressure, sensory dermatome level, Motor blocked level, pain and VAS were recorded at different time intervals. The side effects were also noted.Results: The baseline parameters were comparable among the groups. All the hemodynamic parameters and other study parameters were similar at Min. 0. All the hemodynamic parameters such as heart rate, blood pressure and SpO2 were variable at different time intervals. Motor block level   was significantly (p<0.05) lower in Group C than Group A and Group B from Min 50 to Min 90. The sedation score was observed to be nil in Group C. The post-op pain score became higher in Group C than Group A and Group B at subsequent time intervals. A 3 (10%) of the rescue agents was observed in Group C. Atropine (30%) and mephenteramine (10%) were common rescue agents in Group B. The bradycardia was observed in 30% patients of Group B and in 40% of Group A.Conclusions: On addition of dexmedetomidine as adjuvant to bupivacaine in epidural anesthesia provides better anesthesia and sedation than clonidine as adjuvant to bupivacaine or bupivacaine alone with mild hemodynamic changes which are easily manageable.

scholarly journals A comparative study between dexmedetomidine and dexamethasone as an intrathecal adjuvant for prevention of perioperative shivering in cesarean section

2020 ◽  
Vol 12 (1) ◽  
Author(s):  
Mohamed Abdul Mohsen Abdul Naiem Ismaiel ◽  
Omar Mohamed Taha El Safty ◽  
Ashraf El Sayed El-Agamy ◽  
Omar Mohamed Zafer Mohamed ◽  
Mohamed Mourad Mohsen Mohamed Ali
Keyword(s):  
Cesarean Section ◽  
Statistical Difference ◽  
Sensory Block ◽  
List Type ◽  
Hyperbaric Bupivacaine ◽  
Analgesic Requirement ◽  
Number Of Patients ◽  
Duration Of Surgery ◽  
Group A ◽  
Group B

Abstract Background One of the most common problems in parturients receiving regional anesthesia during cesarean section is shivering. It usually interferes with the readings of the oxygen plethysmography (SpO2) and electrocardiogram (ECG). It expands the needs for oxygen and increases creation of carbon dioxide about four folds. The aim of this work is to compare the efficacy of dexamethasone and dexmedetomidine in prevention of perioperative shivering when added to hyperbaric bupivacaine intrathecally in cesarean sections (CS) and their effect on the intraoperative hemodynamics, intensity of the block, sedation, and postoperative analgesic requirement. Results Study included 60 obstetric patients who fulfilled all the inclusion criteria and were randomized into 2 equal groups, each consisting of 30 patients, namely group A (dexmedetomidine group) and B (dexamethasone group). Group A patients received 5 μg dexmedetomidine with 12.5 mg hyperbaric bupivacaine 0.5% intrathecally. Group B patients received 8 mg dexamethasone then 12.5 mg hyperbaric bupivacaine 0.5% intrathecally. The comparison included assessment of intra- and postoperative hemodynamics, duration of surgery, assessment of sensory and motor block, assessment for shivering and sedation, and assessment of adverse events. This study showed that there were a small number of patients complaining of shivering (five patients in group A and seven patients in group B) with no statistical difference between both groups in the incidence and intensity of shivering. Time to two segment regression (minutes) was longer in group B compared to group A, and also, time to first analgesic rescue was longer in group B compared to group A. For sedation intensity, there was statistical difference between both groups as all patients in group A were sedated compared to six patients only in group B. There was no statistical difference between both groups as regards incidence of adverse effects. Conclusion We concluded that both drugs can be added safely to bupivacaine, and both dexmedetomidine and dexamethasone decreased the incidence and the intensity of shivering. Dexamethasone was found to prolong the duration of sensory block and delay opioid requirements post-operatively, while dexmedetomidine is more effective in sedating the patients intra- and postoperatively.

scholarly journals Is Local Anesthetic Infiltration Prior to Intravenous Cannulation Beneficial to Patients?

2013 ◽  
Vol 8 (1) ◽  
pp. 10-13
Author(s):  
Babu Raja Shrestha ◽  
U Shrestha ◽  
A Shrestha ◽  
A Rana
Keyword(s):  
Heart Rate ◽  
Local Anesthetic ◽  
Randomized Study ◽  
Cardiovascular Responses ◽  
Control Group ◽  
Venous Cannulation ◽  
Number Of Patients ◽  
Group A ◽  
Group B ◽  
Local Anesthetic Infiltration

Aims: Intravenous cannulation causes pain, anxiety and frustration in patients along with changes in hemodynamic parameters. Infiltration of local anesthetic lessens the pain of intravenous cannulation. This study was performed to compare cardiovascular responses and verbal rating pain scores in two groups with and without local anesthetic infiltration prior to venous cannulation. Methods: This was a randomized study conducted in 100 elective surgical patients, divided into two study groups with 50 patients in each: group A (Control) and group B (local anesthetic infiltration). Prior to venous cannulation in group B, 0.5 ml of 1% lidocaine was infiltrated at the procedure site at dorsum of the wrist. Patients in group A were cannulated directly without local anesthetic infiltration. The hemodynamic changes pre and post cannulation and verbal pain rating scores were recorded by blind observers in all patients. Results: Demographic values in two groups were similar. Increase in heart rate from baseline value was significant in control group (p < 0.05). Post cannulation heart rate, systolic and diastolic blood pressure were significantly higher in group A compared to group B for the first three minutes (p < 0.05). Amongst higher number of patients in group A, verbal rating pain score was significantly higher. Ninety-four percent of the patients in group B were pain free, comfortable and satisfied with the procedure. Conclusions: Intravenous cannulation can be made pain free with patient satisfaction and hemodynamic stability if carried out with prior local anesthetic infiltration. Nepal Journal of Obstetrics and Gynaecology / Vol 8 / No. 1 / Issue 15 / Jan- June, 2013 / 10-13 DOI: http://dx.doi.org/10.3126/njog.v8i1.8853

scholarly journals Comparison of Ketamine, Fentanyl and Clonidine as an Adjuvant During Bupivacaine Caudal Anaesthesia in Paediatric Patients

2013 ◽  
Vol 10 (3) ◽  
pp. 25-29
Author(s):  
Jeevan Singh ◽  
RS Shah ◽  
N Vaidya ◽  
PK Mahato ◽  
S Shrestha ◽  
...  
Keyword(s):  
Side Effects ◽  
Normal Saline ◽  
Saline Group ◽  
Single Shot ◽  
Normal Saline Group ◽  
Post Operative Pain ◽  
Caudal Anaesthesia ◽  
Caudal Analgesia ◽  
Lower Pain ◽  
Group B

Background Caudal epidural analgesia with bupivacaine is very popular in paediatric anaesthesia for providing intra- and postoperative analgesia. Several adjuvants have been used to prolong the action of bupivacaine. Objectives To compare the efficacy of ketamine, fentanyl and clonidine in terms of quality and duration of analgesia they produce when added with caudal bupivacaine by single shot technique in children. Methods Eighty children, age one to ten years, undergoing sub-umbilical surgery, were prospectively randomized to one of four groups: caudal analgesia with 0.75 ml/kg of 0.25% bupivacaine in normal saline (Group B) or caudal analgesia with 0.75 ml/kg of 0.25% bupivacaine with 1 μg/kg of clonidine in normal saline (Group BC) or caudal analgesia with 0.75ml/kg of 0.25% bupivacaine with ketamine 0.5mg/kg (Group BK) or caudal analgesia with 0.75ml/kg of 0.25% bupivacaine with fentanyl 1mcg/kg (Group BF). Post-operative pain was assessed for 24 hours using the FLACC scale. Results The mean duration of analgesia was significantly longer in Group BC (629.06 ± 286.32 min) than other three groups P < 0.05. The pain score assessed using FLACC scale was compared between the four groups, and children in Group BC had lower pain scores, which was statistically significant. The requirement of rescue medicine was lesser in Group BC. Clonidine in a dose of 1 μg/kg added to 0.25% bupivacaine for caudal analgesia, during sub-umbilical surgeries, prolongs the duration of analgesia of bupivacaine, without any side effects in compare to fentanyl or ketamine. Conclusion We conclude that clonidine in a dose of 1 μg/kg, added to 0.25% bupivacaine for caudal analgesia and administered as a 0.75 ml/kg mixture in children, for sub-umbilical surgery, significantly prolongs the duration of post-operative analgesia when compared to 0.75 ml/kg of 0.25% bupivacaine in normal saline than 0.75 ml/kg of 0.25% bupivacaine with ketamine 0.5 mg/kg or 0.75 ml/kg of 0.25% bupivacaine with fentanyl 1 mcg/kg or 0.75 ml/kg of 0.25% bupivacaine alone, without any side effects. Kathmandu University Medical Journal | VOL.10 | NO. 3 | ISSUE 39 | JUL- SEP 2012 | Page 25-29 DOI: http://dx.doi.org/10.3126/kumj.v10i3.8013

scholarly journals Randomized study of imatinib for chronic myeloid leukemia: comparing standard dose escalation with aggressive escalation

2019 ◽  
Vol 3 (3) ◽  
pp. 312-319 ◽  
Author(s):  
Koichi Miyamura ◽  
Kazunori Ohnishi ◽  
Shigeki Ohtake ◽  
Noriko Usui ◽  
Chiaki Nakaseko ◽  
...  
Keyword(s):  
Dose Escalation ◽  
Standard Dose ◽  
Randomized Study ◽  
Early Time ◽  
Cytogenetic Response ◽  
Molecular Response ◽  
Inadequate Response ◽  
Number Of Patients ◽  
Group A ◽  
Group B

AbstractIn 2007, we conducted a prospective randomized study to compare an aggressive dose escalation (group B, n = 123) with the standard dose escalation proposed by European LeukemiaNet (group A, n = 122). In group B, if patients did not achieve a complete cytogenetic response (CCyR) at 3 months or did not achieve a major molecular response (MR3) at 6 months, imatinib was increased to 600 mg. At 6 months CCyR was achieved in 69.4% and 78.7% of patients in groups A and B, respectively. The rate of MR3 at 12 months and 24 months were similar in group A (52.1% and 70.0%) and group B (58.7% and 68.3%). The cumulative incidence of withdrawal by failure without accelerated/blast phase was higher in group A than in group B (9.2% vs 2.5% at 24 months). At 3 and 6 months, the protocol called for the imatinib dose to increase to 600 mg in 90 patients (74.4%) in group B. Among the 42 patients who received increased dose according to the protocol, 25 (60.0%) achieved MR3 at 12 months, whereas only 14 (35.0%) of 40 patients who did not receive an increased dose achieved MR3 (P &lt; .05). The number of patients who withdrew from this study was similar (group A, 20%; group B, 21%). The early aggressive dose escalation failed to produce a better molecular response at 12 months. However, for patients who tolerate imatinib well, but show inadequate response at an early time point, aggressive dose escalation may contribute to achieving a better outcome. This study was registered at http://www.umin.ac.jp/ctr/ as #R000000965.

scholarly journals Study on antihyperglycemic effect of bromocriptine in dexamethasone induced hyperglycemic wistar rats

2021 ◽  
Vol 10 (6) ◽  
pp. 699
Author(s):  
Rekha M. B. ◽  
Basavaraj Bhandare ◽  
Satyanarayana V. ◽  
Hemamalini M. B.
Keyword(s):  
Diabetes Mellitus ◽  
Normal Saline ◽  
Wistar Rats ◽  
Saline Group ◽  
Control Group ◽  
Normal Saline Group ◽  
Male Wistar Rats ◽  
Group B ◽  
Control Group Group

Background: Diabetes mellitus is a chronic metabolic disorder that develops due to insulin deficiency or insulin resistance. Recent animal and human studies have reported bromocriptine to be effective in the management of type 2 diabetes mellitus. The present study was done to evaluate the antihyperglycemic effect of bromocriptine in dexamethasone induced hyperglycemic rats.Methods: Male wistar rats were used and divided into 5 groups. Dexamethosone was used to induce hyperglycemia in group B-E. Group A was the untreated control group, group B was the standard control group, group C was the oral 10 mg/kg of bromocriptine dissolved in 0.9% normal saline, group D was the oral 20 mg/kg metformin dissolved in 0.9% normal saline, group E was the oral 10 mg/kg bromocriptine+20 mg/kg metformin dissolved in 0.9% normal saline. Fasting blood glucose, post prandial blood glucose and body weight was estimated on day 1, 15, 30.Results: It was seen that dexamethasone induced hyperglycemia and increase in body weight in male wistar rats, which were significantly controlled by oral bromocriptine and bromocriptine with metformin combination.Conclusions: Results obtained from this study showed that bromocriptine can be a promising drug with novel mechanism to treat type 2 diabetes mellitus.

scholarly journals A PROSPECTIVE RANDOMIZED STUDY OF COMPARISON OF PROPHYLACTIC KETAMINE, CLONIDINE AND TRAMODOL FOR THE CONTROL OF SHIVERING UNDER NEURAXIALANAESTHESIA

2021 ◽  
pp. 1-3
Author(s):  
Rajeev Krishan ◽  
Praveen Kumar Singh ◽  
Chandeshwar Choudhary ◽  
Debarshi Jana
Keyword(s):  
Side Effects ◽  
Normal Saline ◽  
Randomized Study ◽  
Muscular Activity ◽  
Carbon Dioxide Production ◽  
Saline Group ◽  
Control Group ◽  
Normal Saline Group ◽  
Biogenic Monoamines ◽  
Subarachnoid Block

Background: Thermoregulatory system coordinates defenses against environmental temperature to maintain internal core temperature within a narrow range, thus optimizing normal body function and homeostasis in humans. Anaesthetic induced thermoregulatory impairment and hence hypothermia in cold environments. Shivering is an important complication of hypothermia. Shivering is an involuntary, oscillatory muscular activity that augments metabolic heat production upto 600% above basal level to increase temperature. It is associated with substantial adrenergic activation, discomfort and can double or even triple oxygen consumption and carbon dioxide production. Potent anti-shivering properties have been attributed to numerous drugs including biogenic monoamines, cholinomimetics, cations, endogenous peptides and possibly N-methyl-D- aspartate (NMDA) receptor antagonists like ketamine, tramadol and clonidine. Aim: To evaluate the effectiveness of prophylactic use of intravenous ketamine, clonidine and tramadol in control of shivering and to note any side-effects of the drugs used. Methods: A total number of 120 ASA I and 2 patients of either sex belonging to age group 18-60 years posted for Lower Abdomen and Lower Limb surgeries under subarachnoid block were divided into four groups of 30 each. Group P (control group): Patients received 10mL of normal saline IV as placebo. Group K: Patients received Inj. Ketamine 0.5mg/kg BW IV diluted to 10ml in Normal Saline. Group C: Patients received Inj. Clonidine 75mcg IV diluted to 10ml in Normal Saline. Group T: patients received Inj. Tramadol 0.5mg/kg BW IV diluted to 10ml in normal saline. Results: We conclude that giving Ketamine 0.5mg/kg,Clonidine 75mcg or tramadol 0.5mg/kg i.v. prophylactically just before subarachnoid block significantly decreased the incidence of shivering without causing any major side effects. Conclusion: Ketamine, Tramadol or Clonidine decrease shivering during spinal anesthesia.

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