title: Sedative and Analgesic Effects of Propofol-Fentanyl Versus Propofol-Ketamine During Endoscopic Retrograde Cholangiopancreatography: A Double-Blind Randomized Clinical Trial.
abstract: BACKGROUND
  Endoscopic retrograde cholangiopancreatography (ERCP) is a painful procedure that requires analgesia and sedation.
  
  
  OBJECTIVE
  In this study, we compared the analgesic and sedative effects of propofol-ketamine versus propofol-fentanyl in patients undergoing ERCP.
  
  
  METHODS
  In this clinical trial, 72 patients, aged 30 - 70 years old, who were candidates for ERCP were randomly divided into two groups. Before the start of ERCP, both groups received midazolam 0.5 - 1 mg. The intervention group (PK) received ketamine 0.5 mg/kg, and the control group (PF) received fentanyl 50 - 100 micrograms. All patients received propofol 0.5 mg/kg in a loading dose followed by 75 mcg/kg/minute in an infusion. The patients, the anesthesiologist, and the endoscopist were unaware of the medication regimen. Sedation and analgesia quality (based on a VAS), blood pressure, respiratory rate, heart rate, arterial oxygen saturation, recovery time (based on Aldrete scores), and endoscopist and patient satisfation were recorded.
  
  
  RESULTS
  The sedative effects were equal in the two groups (P > 0.05), but the analgesic effects were higher in the PF group than in the PK group (P < 0.05). The PK group had higher blood pressure levels in the eighth minute. Respiratory rate, heart rate, and arterial oxygen saturation showed no significant differences between the groups (P > 0.05). Endoscopist satisfaction, patient satisfaction, and recovery time showed no significant differences between the two groups (P > 0.05).
  
  
  CONCLUSIONS
  The results showed that the sedative effect of propofol-ketamine was equal to the propofol-fentanyl combination during ERCP. To prevent respiratory and hemodynamic complications during ERCP, the propofol-ketamine combination should be used in patients with underlying disease.
authors.affiliation: Student Committee Research, The Clinical Research Development Unit of Roohani Hospital, Babol University of Medical Sciences, Babol, Iran.
authors.forename: Fakhroddin
authors.initials: F
authors.lastname: Bahrami Gorji
authors.affiliation: Department of Intensive Care, Babol University of Medical Sciences, Babol, Iran.
authors.forename: Parviz
authors.initials: P
authors.lastname: Amri
authors.affiliation: Department of Gastroenterology, Babol University of Medical Sciences, Babol, Iran.
authors.forename: Javad
authors.initials: J
authors.lastname: Shokri
authors.affiliation: Vice Chancellor, Babol University of Medical Sciences, Babol, Iran.
authors.forename: Hakimeh
authors.initials: H
authors.lastname: Alereza
authors.affiliation: Social Determinants of Health Research Center, Babol University of Medical Sciences, Babol, Iran.
authors.forename: Ali
authors.initials: A
authors.lastname: Bijani
keywords: Analgesia; Fentanyl; Ketamine; Midazolam; Propofol; Sedation