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Objective: To assess the effectiveness of prophylactic intravenous tramadol alone versus a combination of tramadol and ketamine in preventing shivering during spinal anesthesia for lower segment caesarean section. Methods: This double-blind randomized controlled trial was conducted at Ziauddin Hospital, North Nazimabad, Karachi, Pakistan from August 2023 to October 2023. Pregnant women aged between 18 to 40 years meeting American Society of Anesthesiologist physical status I and II admitted in hospital for lower segment caesarian section were enrolled. One group received an injection tramadol 0.5mg/kg whereas the other group received an injection of tramadol 0.25mg/Kg plus an injection ketamine 0.25 mg/Kg. The primary outcomes were incidence of shivering and severity of shivering. Time to shiver and complications were secondary outcomes. Results: Of total 190 patients, the mean age was 25.95 ±3.63 years. Shivering was reported in 96 (50.5%) patients. The incidence of shivering was found significantly lower in tramadol plus ketamine group as compared to tramadol group i.e., 18 (18.7%) vs. 78 (81.3%) (p-value