Ketofol vs Dexamedetomidine Effect on Conscious Sedation for Patients with Chronic Nonsurgical Low Back Pain

Abstract

Abstract Context Treatment of low back pain is challenging. A variety of therapeutic interventions is available, but no single modality appears to be superior, and evaluations vary depending on the cause of pain and on individual, social, and occupational factors. Scientific evidence supports the use of some nonsurgical treatment alternatives in patients with acute and chronic low back pain. Dexmedetomidine had been successfully used in conscious (moderate) sedation as a good competitive to the popular agent (midazolam). Also different concentrations of ketamine and propofol combinations (ketofol) have been used for procedural sedation and analgesia. Objective The aim of this study is to compare the effect of dexamedetomidine and ketofol on conscious sedation in patients undergoing non-surgical interventions for chronic low back pain regards the efficacy of sedation, hemodynamic stability, respiratory effects, speed of recovery, analgesic effects and incidence of complications. Methodology This study was conducted in Ain Shams University affiliated hospitals on 60 patients of both sexes between 30 and 50 years old, of ASA physical status I–II scheduled for nonsurgical intervention for chronic low back pain. In the current study, the patients were randomly divided into 2 equal groups of 30 patients each. Patients received either sedation with Ketofol (group K) or Dexmedetomidine (group D). Results As regards the demographic data (age, sex and body weight); there was no statistically significant variation between the two study groups. This provided a uniform platform to evenly compare the results obtained. Concerning the duration of the procedure, the time recorded for each patient showed statistically non-significant difference between the two groups. Regarding sedation of the patients during the procedure evaluated according to Ramsay sedation score, there was a highly significant difference between the two groups (p-value < 0.001), where the dexmedetomidine group needed more time (17.71 ± 2.86 min) to reach the targeted Ramsay sedation score (3-4) to commence the surgical procedure while the ketofol group needed less time (9.79 ± 1.87 min) to reach the same score. Conclusion Both drugs provided hemodynamic stability althrough the procedure although dexmedetomidine group showed lower heart rates and lower mean arterial blood pressures towards the end of the procedure which makes it difficult to be used in older population or those having low baseline heart rates. Both drugs proved to be safe concerning respiration, SPO2 and CO2 values, however dexmedetomidine showed higher respiratory rates during the procedure.