A Comparison between 2 Different Proportions of Ketamine-Propofol and Propofol-Fentanyl for Procedural Sedation and Analgesia for Minor Gynaecological Procedures: A Prospective Randomized Control Trial

OBJECTIVE: There are many minor gynaecological procedures being done worldwide on an outpatient basis under procedural sedation and analgesia. Our objective was to compare the efficiency of two different proportions of ketamine-propofol (1:1 and 1:2) with propofol-fentanyl for such procedures with respect to onset and depth of anaesthesia, intraoperative hemodynamics, post operative pain relief, recovery time and incidence of adverse effects. METHODS: The prospective, randomised controlled study was conducted at the Government RSRM Lying-In hospital, Stanley medical college, Chennai – 1 from August 2019 to January 2020. After obtaining informed consent, 90 adult females between the ages of 18 to 50 who met the inclusion criteria for our study were chosen and were divided randomly into 3 study groups of 30 participants each. Group 1 patients received 100 mg ketamine + 100 mg propofol iv in titrated doses. Group 2 patients received 50 mg ketamine + 100 mg propofol iv in titrated doses. Group 3 patients received 100 mg propofol + 100 mcg fentanyl iv in titrated doses. After placing all standard monitors, 3 ml of drug mixture was given in all 3 groups with the dose being repeated till a Ramsay sedation score (RSS) of 5-6 was achieved, after which the surgeon was asked to proceed. 1 ml of the drug mixture was given intraoperatively on patient’s movement to painful stimulus. Non invasive blood pressure, heart rate, oxygen saturation, respiratory rate and end tidal carbon dioxide were assessed at baseline, after giving the drugs and then every 5 minutes thereafter. RSS, EVANS score (depth of anaesthesia) were recorded every 5 minutes intraoperatively and at the end of the procedure. Modified Aldrete score for recovery and post operative Wong-Baker FACES Pain scale for pain relief were used. Post operative hemodynamics were also monitored at 0, 5, 10 and 15 minutes. RESULTS: High statistical significance was noted in terms of induction time, i.e faster induction was found with the ketamine-propofol 1:1 group (p<0.01), volume of drug consumed (p<0.01), recovery time (p<0.01) and postoperative pain relief at 10 minutes (p<0.05) and 15 minutes (p