Ketofol Infusion as a Procedural Sedation and Analgesia Modality for Minor Orthopedic Surgeries: Evaluation of Dose-Outcome Relation

Objectives: To evaluate dose-outcome relation of ketofol procedural sedation and analgesia (PSA) used for minor orthopedic surgeries. Patients Methods: 90 patients attended the emergency department (ED) with distal end of radius fracture required closed reduction and slab fixation without the need for open surgical interference and were randomly allocated into 3 equal (n=30) study groups assigned to receive sedation solution using propofol (0.5 mg/kg/hr) and ketamine (0.5 mg/kg/hr) infusion mixture in 1:1 ratio (Group A), 2:1 ratio (Group B), and 3:1 ratio (Group C). All patients were monitored non-invasively for arterial blood pressure, heart rate, oxygen saturation, and respiratory rate; sedation scoring according to the Observer Assessment of Alertness/Sedation (OAA/S) scale and postoperative (PO) pain was judged using a 0-100 visual analogue pain scale (VAS). PO duration of hospital stay and the frequency of PO side effects were reported and patients satisfaction was assessed using a 4-point verbal rating scale. Results: Surgical procedure was completed successfully with minor hemodynamic changes (52.5%) and spared PO analgesia in about 40% of patients. Significantly more hemodynamic stability and less frequency of respiratory depression was reported in group A compared to group C. Patients received 1:1 infusion had significantly lower sedation scores, sedation duration and shorter duration of PO stay and total duration of hospital stay compared to groups B and C with significant difference in favor of group B. However, patients received 1:1 infusion experienced significantly higher VAS pain scores with non-significantly higher consumption of rescue analgesia compared to groups B and C. Patients received 2:1 ketofol infusion reported significantly higher satisfaction about both sedation and analgesia compared to groups A and C with significantly higher satisfaction in favor of group A. PO nausea and vomiting occurred in 13 patients (14.4%) and over-sedation in 10 patients (11.1%) with non-significant difference among studied groups despite being in favor of group A. No psychomotor or behavioral sequlae were reported with the used dose of ketamine. Conclusion: Ketofol infusion in 2:1 ratio could be considered the appropriate PSA modality for minor orthopedic surgeries providing short PO and total hospital stay with minor hemodynamic changes and PO side effects and acceptable levels of both PO analgesia and sedation.