Comparison of propofol and ketofol for sedation in patients undergoing shoulder surgery with interscalene and suprascapular nerve blocks

Abstract

Introduction and Purpose: We compared propofol and ketofol for sedation in patients who underwent shoulder arthroscopy under anesthesia with interscalene and suprascapular blocks. We evaluated both of agents the intraoperative hemodynamic effects, sedation efficiency, postoperative recovery times and the time to discharge to the service. We aimed to achieve an effective sedation with stable hemodynamics, resulting in rapid recovery with early onset. Methodology: The study was carried out prospectively in a double-blind randomized study on ASA I and II patients aged 18-65, total of 42 shoulder surgeries planned. Anesthesia was provided to the patients by performing interscalene and suprascapular nerve block with USG. Group 1 (Propofol group), 1 mg/kg propofol iv, in Group 2 (Ketofol group), a mixture of ketamine-propofol was prepared in a 1:1 ratio, 1 mg / kg ketofol iv was administered. Processing was started in both groups when Ramsey Sedation Scale (RSS) was 3. SBP, DBP, MBP, heart rate, O2 saturation, RSS, Faces scale were recorded throughout the case. The patients with an Aldrete score of 9 were discharged and sent to the service. Results: A total of 42 patients undergoing planned shoulder surgeries were enrolled. No statistically significant was determined between the groups in respect of demographic data (age, gender, height, weight, ASA), operating time and postoperative length of stay in hospital. More patients required esmolol in the ketofol group compared to propofol group; 15 (71.4%) vs. 7 (33%) patients (p < 0.05). Significant higher mean values of hemodynamic findings in the ketofol  group were noted; SBP at 55 min, DBP at 60 min, MBP at 60 min and MBP on discharge (p < 0.05). In the absence of esmolol, the pulse measurements at 0, 1, 3, 25, and 30 min were determined to be statistically significantly higher in the ketofol group than the propofol group (p < 0.05). The mean values of the SpO2 measurements were significantly lower in the ketofol group (p < 0.05). No statistically significant difference was determined in respect of the postoperative modified Aldrete Scores (MAS) at any of the time points (p > 0.05). Conclusion: While a deeper and higher quality sedation was provided with ketofol, we achieved rapid onset and short-acting sedation with propofol. Both agents have different superior properties and can be used safely for sedation. Key words: Brachial plexus block, ketofol, shoulder arthroscopy, propofol, sedation Citation: Akcaalan Y, Sahap M, Gulec H, Horasanli E, Ugurlu M, Akcaalan S. Comparison of propofol and ketofol for sedation in patients undergoing shoulder surgery with interscalene and suprascapular nerve blocks. Anaesth. pain intensive care 2022;26(1):102-109. DOI: 10.35975/apic.v26i1.1775 Received: September 24, 2021, Reviewed: October 18, 2021, Accepted: Nov 09, 2021