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Comparison Between Ketamine and Paracetamol in The Prevention of Post-Spinal Anesthesia Shivering in Caesarean Section Procedures

Department of Anesthesiology and Intensive Care, Faculty of Medicine, Universitas Diponegoro/Dr. Kariadi General Hospital, Semarang, Indonesia

Received: 5 Dec 2024; Revised: 21 Feb 2026; Accepted: 24 Feb 2026; Available online: 24 Apr 2026.
Open Access Copyright 2026 JAI (Jurnal Anestesiologi Indonesia)
Creative Commons License This work is licensed under a Creative Commons Attribution 4.0 International License.

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Abstract

Background: Shivering is a common complication associated with spinal anesthesia during cesarean sections, leading to discomfort and potential cardiac ischemia. While intravenous paracetamol is known to prevent shivering, it has potential peripheral limitations and may be costly. Conversely, ketamine administration inhibits norepinephrine reuptake, potentially reducing heat redistribution and serving as a more affordable alternative.

Objective: Assessing the comparison of ketamine and paracetamol on the incidence, onset, and degree of post-spinal anaesthesia shivering in caesarean section procedures.

Methods: An experimental design was employed with a sample size of 52 patients, divided into two groups: one receiving intravenous ketamine (0.25 mg/kg) alongside intrathecal bupivacaine (15 mg), and the other receiving intravenous paracetamol (1000 mg) with intrathecal bupivacaine (15 mg). The incidence, onset, and degree of shivering were observed and recorded every 3 minutes for 90 minutes.

Results: The incidence of shivering in the ketamine group was 3 samples while in the paracetamol group there were 10 samples. The mean time of onset of shivering in the ketamine group was 55.00 minutes, and in the paracetamol group was 27.30 minutes (p<0.05). While the degree of shivering in the ketamine group was 1 sample of degree 1 and 2 samples of degree 2, the paracetamol group was 4 samples of degree 2, 3 samples of degree 3 and 3 samples of degree 4 (p<0.05).

Conclusion: Ketamine proved to be more effective in preventing shivering than paracetamol after spinal anesthesia in caesarean section procedures.

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Keywords: caesarean section; ketamin, paracetamol; shivering; spinal anesthesia

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