A randomised controlled trial to compare TIVA infusion of mixture of ketamine propofol (ketofol) and fentanyl-propofol (fentofol) in short orthopaedic surgeries

Propofol does not possesses the analgesic properties but is a safe anaesthetic agent for day care surgeries while ketamine is an excellent analgesic but has concerns regarding recovery. Fentanyl is a short acting potent opioid with pharmacokinetics suitable for day care anaesthesia. There are many short procedures in which you need procedural sedation with good analgesia and calm patient without need of intubation and relaxation. This study was conducted to compare and find suitable sedoanalgesia regime of TIVA using Propofol-Ketamine (Ketofol) or Propofol -Fentanyl (Fentofol) mixture infusion to facilitate comfortable and stable sedation experience with rapid recovery in short orthopaedic surgeries.

Randomized, Double blind.

This prospective, randomized, double-blind study was conducted on 100 adult patients of age 20–55 years of either sex having ASA physical status I-II, posted for short orthopaedic procedures. Patients were assigned to receive slow bolus of fresh premixed injection of either ketofol or fentofol followed by TIVA infusion to a predetermined sedation level using Ramsay sedation scale. Haemodynamics, vital signs, side effects and recovery profiles were recorded.

There was significant decrease (P<0.001) in the pulse rate, systolic and diastolic blood pressure in intraoperative and postoperative period in group II (FP, fentanyl group) whereas there was significant rise in pulse rate and systolic and diastolic blood pressure in group I (KP, ketamine group). Respiratory depression was more pronounced in fentofol group. Total dose of propofol consumed was less in ketofol group with less involuntary movements. Mean total sedation time as well as recovery time was significantly prolonged in fentofol group compared to ketofol group. No major adverse effects were observed with ketofol group.

As compared to fentofol, continuous TIVA infusion with ketofol (1:1) provided better sedoanalgesia, stable haemodynamics with favourable recovery profile.