Tramadol is a narcotic-like pain reliever. It is a synthetic, centrally acting analgesic drug with two distinct, synergistic mechanisms of action. Usually, Tramadol is used to manage moderate to severe surgical pain but it has shown anti-shivering effect in some setting. Tramadol is a weak opioid agonist and an inhibitor of monoamine neurotransmitter reuptake. It could inhibit the reuptake of 5-hydroxy tryptamin, Norepinephrine, and Dopamine [1]. . .