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

Abstract

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 4.57 units in the KF group and 3 units in the FZ group (P < 0.001); this decrease was more significant in the KF group in comparison with the FZ group (P < 0.001). The patients’ sedation score during the procedure was 3.43±0.73 and 2.4 ± 0.49 in KF and FZ groups, respectively (P < 0.001). The 5th minute systolic blood pressure was significantly higher in the KF group in comparison with the FZ group (P < 0.001). The 5th minute diastolic blood pressure was significantly more in the KF group in comparison with the FZ group (P < 0.001). The 5th minute pulse rate was significantly greater in the KF group in comparison with the FZ group (P < 0.001). The mean recovery time was significantly more in the FZ group (25.6 versus 18.67 minutes, P < 0.001). The mean patient’s satisfaction was 4.37 ± 0.85 in the KF group and 3.73 ± 0.87 in the FZ group (P = 0.006), and the mean doctor’s satisfaction was 4.35 ± 0.89 in the KF group and 3.27 ± 1.08 in the FZ group (P < 0.001). 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.