Propofol-Ketamine vs. Propofol-Fentanyl Combinations in Patients Undergoing Closed Reduction: A Randomized, Double-blind, Clinical Trial

Abstract

Introduction: Painful surgical procedures require adequate sedation and analgesia. A vast array of medications can be used for Procedural Sedation and Analgesia (PSA) in Emergency Departments (EDs). Objective: The present study was conducted to compare Propofol-Ketamine (PK) and Propofol-Fentanyl (PF) compounds in patients undergoing closed reduction in EDs. Methods: This randomized, double-blind, clinical trial was conducted on 110 consecutive patients who required sedation for closed reduction. The patients were randomly divided into two groups of equal sizes. The PK group received an intravenous bolus of 1 mg/kg of propofol plus 0.5 mg/kg of ketamine, and the PF group received an intravenous bolus of 1 mg/kg of propofol plus 1 µg/kg of fentanyl. The analgesic effect and success rate were the primary outcomes under study. Results: The PK group achieved more effective analgesia at the end of the experiment. The success rate was almost the same in both groups Shivering (p=0.005) and a drop in oxygen saturation to below 92% (p=0.048) were two side effects that were more prevalent in the FK group . The mean recovery time was significantly shorter in the PK group (p<0.001). The patients in the PK group were more satisfied. Conclusion: In comparison with the PF compound, the use of KP leads to better pain relief and greater patient satisfaction and shorter sedation time in PSA.

1. Miner JR, Moore JC, Austad EJ, Plummer D, Hubbard L, Gray RO. Randomized, double-blinded, clinical trial of propofol, 1:1 propofol/ketamine, and 4:1 propofol/ketamine for deep procedural sedation in the emergency department. Ann Emerg Med. 2015;65(5):479-88.e2.
2. Zeballos JL, Lirk P, Rathmell JP. Low-Dose Ketamine for Acute Pain Management: A Timely Nudge Toward Multimodal Analgesia. Reg Anesth Pain Med. 2018;43(5):453-5.
3. Hijazi Y, Bodonian C, Bolon M, Salord F, Boulieu R. Pharmacokinetics and haemodynamics of ketamine in intensive care patients with brain or spinal cord injury. Br J Anaesth. 2003;90(2):155-60.
4. Bourgoin A, Albanese J, Wereszczynski N, Charbit M, Vialet R, Martin C. Safety of sedation with ketamine in severe head injury patients: comparison with sufentanil. Crit Care Med. 2003;31(3):711-7.
5. Allen CA, Ivester JR, Jr. Ketamine for Pain Management-Side Effects & Potential Adverse Events. Pain Manag Nurs. 2017;18(6):372-7.
6. Abdolrazaghnejad A, Banaie M, Tavakoli N, Safdari M, Rajabpour-Sanati A. Pain Management in the Emergency Department: a Review Article on Options and Methods. Adv J Emerg Med. 2018;22(4):e*.
7. Hwang J, Jeon Y, Park HP, Lim YJ, Oh YS. Comparison of alfetanil and ketamine in combination with propofol for patient-controlled sedation during fiberoptic bronchoscopy. Acta Anaesthesiol Scand. 2005;49(9):1334-8.
8. Sajedi P, Yaraghi A, Bigi AA, Rezaie M, Mehrabi Kooshki A. Comparative Evaluation of Vital Signs Stability, Sedation and Analgesia Scores with Two Methods of Sedation: Propofol+ Fentanyl and Ketamine+ Fentanyl during Perm Cath Insertion. Pajouhesh dar Pezeshki. 2010;34(1):13-9 (Persian).
9. Rama-Maceiras P, Ferreira TA, Molins N, Sanduende Y, Bautista AP, Rey T. Less postoperative nausea and vomiting after propofol + remifentanil versus propofol + fentanyl anaesthesia during plastic surgery. Acta Anaesthesiol Scand. 2005;49(3):305-11.
10. Camu F, Vanlersberghe C. Pharmacology of systemic analgesics. Best Pract Res Clin Anaesthesiol. 2002;16(4):475-88.
11. Morse Z, Sano K, Kanri T. Effects of a propofol--ketamine admixture in human volunteers. Pac Health Dialog. 2003;10(1):51-4.
12. Kb N, Cherian A, Balachander H, Kumar CY. Comparison of Propofol and Ketamine versus Propofol and Fentanyl for Puerperal Sterilization, A Randomized Clinical Trial. J Clin Diagn Res. 2014;8(5):Gc01-4.
13. Khajavi M, Emami A, Etezadi F, Safari S, Sharifi A, Shariat Moharari R. Conscious Sedation and Analgesia in Colonoscopy: Ketamine/Propofol Combination has Superior Patient Satisfaction Versus Fentanyl/Propofol. Anesth Pain Med. 2013;3(1):208-13.
14. Khutia SK, Mandal MC, Das S, Basu SR. Intravenous infusion of ketamine-propofol can be an alternative to intravenous infusion of fentanyl-propofol for deep sedation and analgesia in paediatric patients undergoing emergency short surgical procedures. Indian J Anaesth. 2012;56(2):145-50.
15. Akin A, Guler G, Esmaoglu A, Bedirli N, Boyaci A. A comparison of fentanyl-propofol with a ketamine-propofol combination for sedation during endometrial biopsy. J Clin Anesth. 2005;17(3):187-90.
16. Goh PK, Chiu CL, Wang CY, Chan YK, Loo PL. Randomized double-blind comparison of ketamine-propofol, fentanyl-propofol and propofol-saline on haemodynamics and laryngeal mask airway insertion conditions. Anaesth Intensive Care. 2005;33(2):223-8.
17. Vallejo MC, Romeo RC, Davis DJ, Ramanathan S. Propofol-ketamine versus propofol-fentanyl for outpatient laparoscopy: comparison of postoperative nausea, emesis, analgesia, and recovery. J Clin Anesth. 2002;14(6):426-31.
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IssueVol 2 No 4 (2018): Autumn (October) QRcode
SectionOriginal article
PMCIDPMC6548145
PMID31172107
Keywords
Analgesia Emergency department Fentanyl Ketamine Pain, procedural Propofol
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How to Cite
1.
Mofidi M, Rouhi R, Mahshidfar B, Abbasi S, Hafezimoghadam P, Rezai M, Farsi D. Propofol-Ketamine vs. Propofol-Fentanyl Combinations in Patients Undergoing Closed Reduction: A Randomized, Double-blind, Clinical Trial. Front Emerg Med. 2018;2(4):e44.

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