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To compare the efficacy of tramadol with pethidine on the treatment of post spinal anaesthesia shivering. Electronic databases including PubMed, Google Scholar, Embase and Cochrane were searched to find the randomized controlled trials (RCTs) comparing the efficacy of tramadol with pethidine on the treatment of post spinal anaesthesia shivering. Review Manager 5.3 was used. The meta-analysis was conducted with fixed-effect model or random-effect model according to the heterogeneity. Seven randomized controlled trials involving 463 patients were included. Compared with pethidine, tramadol had a significantly higher incidence of effective rate of shivering treatment (OR: 3.02, 95% CI 1.25 to 7.28, P = 0.01; I2 = 0%), shorter time to cease shivering (mean difference − 1.72, 95% CI − 2.59 to − 0.84, P = 0.0001; I2 = 89%) and lower recurrent rate of shivering (OR 0.18, 95% CI 0.05 to 0.57, P = 0.004; I2 = 0%), with a lower incidence of nausea and vomiting (OR 0.20, 95% CI 0.09 to 0.41, P < 0.0001; I2 = 23%). There was no significant difference in the incidence of pruritus between tramadol and pethidine. Tramadol is superior to pethidine when used for shivering treatment after spinal anaesthesia. [ABSTRACT FROM AUTHOR]