Comparison of Pre-emptive Usage of Ketamine and Combination of Ketamine With Midazolam to Prevent Shivering During Neuraxial Block

Arun Kumar, Haris Tariq Chohan, Muhammad Imran Riasat, Syed Farjad Sultan, Sunil Arjan, Safia Zafar Siddiqui

  • Arun Kumar Department of Anaesthesiology SICU & Pain Management, Dr. Ruth K.M Pfau Civil Hospital Karachi



To evaluate the effectiveness of pre-emptive usage of intravenous ketamine and combination of ketamine with midazolam to control shivering during neuraxial block.

Study design

Comparative study.

Place & Duration of study

Department of Anesthesiology, Surgical Intensive Care Unit and Pain Management, Dr. Ruth K.M Pfau Civil Hospital Karachi (CHK), from May 2015 to October 2015.


Patients were divided into two groups. Group K received ketamine 0.5mg/kg and in group KM, ketamine 0.25mg/kg and midazolam 37.5 microgm/kg were given. Just after subarachnoid block, all study drugs were administered through intravenous route as bolus dose. Data were entered into a predesigned form. Data analysis was done with SPSS version 17. Chi square test was applied for statistical significance.


The mean age of the patients was 36.12±6.78 year. There were 73 (81.1%) male and 17 (18.9%) female patients. Rate of postoperative shivering was significantly low in group KM as compared to group K (13.3% vs. 64.4% - p=0.005). Side effects of ketamine were also less in KM group.


The combination of reduced dose of  ketamine plus midazolam was superior to ketamine alone in preventing shivering  during spinal anesthesia.

Key words

Shivering, Ketamine, Midazolam, Spinal anesthesia.