Background: Post-operative shivering is a common complication following spinal anesthesia. This study compared the efficacy of tramadol versus paracetamol in preventing this complication.Methods: Sixty patients undergoing surgery under spinal anesthesia were randomly assigned to receive either tramadol (n=30) or paracetamol (n=30). The incidence, severity, and onset of shivering, as well as side effects and response to rescue medication, were assessed.Results: The overall incidence of shivering was 26.7%. Tramadol group showed a higher percentage of patients with no shivering (80% vs 66.7%) and lower incidence of severe shivering (3.3% vs 13.3%) compared to the Paracetamol group. Shivering onset was earlier in the tramadol group (10 ± 3 minutes vs 15 ± 4 minutes, p = 0.045). Tramadol group experienced higher rates of nausea (20%) and vomiting (6.7%) compared to paracetamol group (0% for both). Pethidine as rescue medication was effective in 80% of paracetamol group cases and 100% of tramadol group cases requiring intervention.Conclusion: Both tramadol and paracetamol demonstrated efficacy in preventing post-operative shivering, with tramadol showing higher efficacy but more side effects. The choice between these agents should be individualized based on patient factors and clinical context.