*Ketamine:* Ketamine is a medication that can help reduce shivering by blocking certain nerve signals in the brain. It's like a "nerve blocker" that helps calm down the body's shivering response.

- *Tramadol:* Tramadol is a pain medication that can also help reduce shivering. It works by affecting the brain's temperature regulation centers, which helps to reduce the shivering response.

Post-spinal shivering is when a patient starts shaking or shivering after receiving spinal anesthesia. This can be uncomfortable and even scary for the patient.

Using ketamine and tramadol to reduce post-spinal shivering can have several benefits, including:

• Reduced discomfort and anxiety for the patient
• Improved patient satisfaction
• Reduced need for additional medications or interventions
• Faster recovery times

Inclusion Criteria:

• Pateint for elective cesarean section
• Age 18 to 40 years
• ASA 1 and 2

Exclusion Criteria:

• ASA 2 and 3
• Cesarean section requiring general anesthesia
• Hypersensitivity to Ketamine, Tramadol and Opiods
• History of cardiovascular disease

Patient confidentiality*: Sharing IPD could compromise patient confidentiality and anonymity, potentially harming participants or their families.

• Informed consent*: Participants may not have provided informed consent for their data to be shared, which could raise ethical concerns.