Comparing Propofol-Ketamine and Propofol-Fentanyl as Procedural Sedation and Postoperative Analgesia for Total Intravenous Anaesthesia in Adult Patients Undergoing Short Surgical ProceduresA Randomised Clinical Study

Abstract

Introduction: Total Intravenous Anaesthesia (TIVA), an immensely popular procedure of recent times is most often conducted using propofol as the main anaesthetic agent. Ketamine or fentanyl has also been regularly used to compliment with their analgesic action, which propofol lacks. Aim: To compare the induction characteristics, maintenance of anaesthesia, awakening and recovery characteristics while performing TIVA with either propofol-ketamine or propofol-fentanyl combinations. Materials and Methods: This randomised, single blinded study was conducted, from March 2020 to August 2021, in a tertiary care centre of Kolkata, India. Total of 76 patients of either sex, aged between 18-45 years with an American Society of Anesthesiologists (ASA) physical status I and II, who were posted for short surgical procedures, with a duration of surgery less than 30 mins were equally divided into two groups. Group A received propofol ketamine (1:1), prepared by mixing 4 mL ketamine (50 mg/mL) with 20 mL of 1% Propofol (10 mL/kg), while group B received propofol-fentanyl solution (1:1) was prepared by mixing 4 mL (50 µg/mL) of fentanyl with 20 mL of 1% propofol (10 mg/mL). Induction was done with ketamine 10 mg/ kg+propofol 1 mg/kg in group A and fentanyl 1.5 µg/kg+propofol 1.5 mg/kg while maintenance of anaesthesia was achieved with continuous infusion of the prepared solutions for either group respectively at a rate of around 20 mL/hour or more, as per required to maintain the Ramsay Sedation Scale (RSS) score of 6. Intraoperative haemodynamic parameters, including respiratory rates, awakening time, recovery time and the possible the side effects were recorded at regular intervals. Student’s t-test was used for quantitative data and Chi-square test for qualitative data. A p-value of less than 0.05 was considered statistically significant. Results: Patients of group B developed significantly more incidents of bradycardia (20 in group B and 3 in group A) and hypotension (28 in group B and 2 in group A). Respiratory depression was also significantly more in group B (p-value<0.005).However, recovery, awakening, VAS score and other side effect profiles were all comparable in the two groups. Conclusion: Propofol-ketamine provides equipotent analgesia with better haemodynamic control and minimal side effects in comparison to propofol-fentanyl while used in TIVA for adult patients undergoing short surgical procedures.