Comparison of Ketamine plus Dexamethasone versus Ketamine Alone for Prevention of Severe Shivering After Spinal Anesthesia in Caesarean Section

Mahmoud, Ahmed Omar; Abdel Sabour, Ahmed Ismail; Atteia, Waleed Ahmad Ali Hussein; Ibrahim, Gamal Mohamed Anu Dahab; Ahmed, Ahmed Abdelkader; Bakr, Mostafa Hassanien Hassanien

doi:10.21608/egja.2025.360269.1019

Comparison of Ketamine plus Dexamethasone versus Ketamine Alone for Prevention of Severe Shivering After Spinal Anesthesia in Caesarean Section

Document Type : Original Article

Authors

¹ Department of Anesthesia and Intensive Care, Faculty of Medicine, New Valley University, Egypt.

² Department of Gynaecology and Obstetric department, Faculty of Medicine, New Valley University, Egypt.

³ Department of Anesthesia and Intensive Care, Faculty of Medicine, Assiut University, Egypt.

⁴ Anaesthesia and Intense Care Unite, King Saud University, Riyadh.

10.21608/egja.2025.360269.1019

Abstract

Background: Post-anesthetic shivering is a common complication following spinal anesthesia in cesarean sections, increasing oxygen consumption and patient discomfort. While ketamine has demonstrated efficacy in preventing shivering, its use alone may not provide optimal protection. To evaluate the efficacy of combined ketamine and dexamethasone versus ketamine alone in preventing post-spinal shivering during cesarean section.
Patients and Methods: This randomized, double-blind trial included 182 parturients undergoing elective cesarean section under spinal anesthesia, randomly allocated to receive either ketamine 0.25 mg/kg (Group K, n=91) or ketamine 0.25 mg/kg plus dexamethasone 0.1 mg/kg (Group KD, n=91). Primary outcomes included incidence and severity of shivering. Secondary outcomes included time to onset, duration of shivering, hemodynamic parameters, and adverse effects.
Results: The combination therapy showed significantly lower shivering incidence (20.9% vs 40.7%, P<0.001) and delayed onset (25.7±6.1 vs 18.4±5.2 minutes, P<0.001) compared to ketamine alone. Shivering duration was shorter in the combination group (28.5±7.4 vs 42.3±8.7 minutes, P<0.001). The combination group demonstrated better sedation profile (P=0.039) with more patients maintaining cooperative orientation (74.7% vs 57.1%). Hemodynamic parameters remained comparable between groups, and no significant differences were observed in adverse effects.
Conclusion: The addition of dexamethasone to ketamine provides superior prophylaxis against post-spinal shivering in cesarean sections, with delayed onset, shorter duration, and better sedation profile, without increasing adverse effects.

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