Comparison of Analgesic and Sedative Effects of Ketamine-Propofol (Ketofol) and Fentanyl-Midazolam (Fentazolam) Combinations in Outpatient Orthopedic Procedures

Background: Pain control is essential for ideal care of surgery patients. Noninvasive or minimally invasive procedures outside the operation room have had an increasing trend in the recent years. Sedation, analgesia or both may be necessary for the majority of these diagnostic or interventional procedures. Objectives: We sought to compare sedative and analgesic effects of Ketamine-Propofol (Ketofol) and Fentanyl-Midazolam (Fentazolam) Combinations in emergent outpatient orthopedic operations. Methods: Sixty male candidates for closed reduction of Colle’s fracture were divided into two groups of ketamine-propofol (Ketofol, KF) and fentanyl-midazolam (Fentazolam, FZ). Pain, sedation score, hemodynamic variables, recovery times, patients’ and the operator’s satisfaction and complications were evaluated. Results: Pain score decreased ۴.۵۷ units in the KF group and ۳ units in the FZ group (P < ۰.۰۰۱); this decrease was more significant in the KF group in comparison with the FZ group (P < ۰.۰۰۱). The patients’ sedation score during the procedure was ۳.۴۳±۰.۷۳ and ۲.۴ ± ۰.۴۹ in KF and FZ groups, respectively (P < ۰.۰۰۱). The ۵th minute systolic blood pressure was significantly higher in the KF group in comparison with the FZ group (P < ۰.۰۰۱). The ۵th minute diastolic blood pressure was significantly more in the KF group in comparison with the FZ group (P < ۰.۰۰۱). The ۵th minute pulse rate was significantly greater in the KF group in comparison with the FZ group (P < ۰.۰۰۱). The mean recovery time was significantly more in the FZ group (۲۵.۶ versus ۱۸.۶۷ minutes, P < ۰.۰۰۱). The mean patient’s satisfaction was ۴.۳۷ ± ۰.۸۵ in the KF group and ۳.۷۳ ± ۰.۸۷ in the FZ group (P = ۰.۰۰۶), and the mean doctor’s satisfaction was ۴.۳۵ ± ۰.۸۹ in the KF group and ۳.۲۷ ± ۱.۰۸ in the FZ group (P < ۰.۰۰۱). Conclusions: Ketamine-Propofol, with lower dose of each drug, had a better sedation and analgesic effect as well as lower complications and shorter recovery time when compared to fentanyl-midazolam.

Keywords:

Ketamine , Propofol , Fentanyl , Midazolam , Sedation , analgesia