Comparison of ketamine-propofol (ketofol) versus midazolam-fentanyl for procedural sedation and analgesia in emergency care department: An open-label randomized controlled study

Background: Various anesthetic drugs are used for procedures conducted outside the operation theater. Very few studies are done in the emergency department to compare the combination of ketamine and propofol (ketofol) versus midazolam-fentanyl for procedural sedation and analgesia, thus we conducted this study to compare these drug combinations in terms of analgesic and sedation efficacy in the emergency department. Materials and Methods: A prospective, open-label, randomized, comparative study was conducted on 60 patients, who were randomly assigned to the ketofol and midazolam-fentanyl groups (30 each) to compare these drugs in terms of sedation efficacy using modified Ramsay sedation score, pain scores using Visual Analog Scale, and alteration of hemodynamic, adverse effects such as respiratory distress and nausea. The mean pain score before and after the study was compared using paired t-test, and the difference between the two groups was assessed using Student's t-test. Chi-square test and Fisher's exact test were employed to compare the distribution of qualitative data. Results: Our study showed that ketofol provides better analgesia as compared to the midazolam-fentanyl group because reduction in Visual Analog Scale scores was 1.27 ± 1.52 (mean ± standard deviation [SD]) in the ketofol group as compared to 3.07 ± 1.25 (mean ± SD) in the midazolam-fentanyl group. Ketofol 4.47±0.73 (mean ± SD) had a better modified Ramsay sedation score when compared to midazolam-fentanyl 3.47±0.90 (mean ± SD). There was reduction in systolic (from 119 ± 18.4 to 113.3 ± 18.81 mmHg) and diastolic blood pressure (from 72 ± 9.61 to 69.67 ± 10.33 mmHg) in the midazolam-fentanyl group during and after the procedure in comparison to the ketofol group where none had hypotension. Conclusion: Results concluded that ketamine-propofol (ketofol) combination is safe and better in providing adequate analgesia and sedation than midazolam and fentanyl combination in the emergency room.