The effects of propofol–fentanyl versus propofol–ketamine on lower limb movement response in patients undergoing outpatient loop electrosurgical excision procedure (LEEP): a randomized double-blind controlled trial

Abstract

Introduction: Cervical cancer is the second most common cancer among Thai women. Lesions are often diagnosed and treated by Loop Electrosurgical Excision Procedure (LEEP), which is typically performed as a one-day surgery. Patient safety is our concern.

Objective: To compare the effects of propofol combined with fentanyl (PF) versus propofol combined with ketamine (PK) administered on patients undergoing outpatient Loop
Electrosurgical Excision Procedures (LEEP) at Pattaya Patthamakun Hospital, and receiving lower limb movement response assessments.

Methods: This randomized double-blind study enrolled 54 patients undergoing outpatient LEEP. Patients were randomly assigned to receive either propofol combined with fentanyl (n = 27) or propofol combined with ketamine (n = 27). The fentanyl dose was 1 mcg/kg and the ketamine dose was 0.75 mg/kg, and was administered intravenously. The primary outcome of this study was to elicit a lower limb movement response. Secondary outcomes included total
propofol dosage, total intravenous fluid, the incidence of hypotension, oxygen desaturation, cough, apnea and the need for jaw-thrust airway interventions, time to emergence and time to recovery. Postoperative pain scores were measured by the visual analog scale (VAS), and included nausea, vomiting and dizziness.
Results: The incidence of lower limb movement response showed no significant difference between the PK group and PF group: (8[29.63%] vs 10[37.04%] respectively, p-value = 0.56). However, the PF group demonstrated significantly lower blood pressure (6[22.22%] vs 0[0.00%],
p-value = 0.01) and required a significantly higher propofol dose per body weight per minutes (0.31[0.23;0.39] vs 0.22[0.19;0.26], p-value = 0.01). The volume of intravenous fluid, incidence of hypotension, oxygen desaturation, cough, apnea, the need for jaw-thrust maneuvers, time to emergence, recovery time and postoperative VAS pain scores were not significantly different between two groups.

Conclusion: The propofol–ketamine combination maintained a more stable blood pressure compared with propofol–fentanyl during LEEP without increasing other adverse effects. However,there was no difference in lower limb movement response between the two groups. The incidence of hypotension in the propofol–fentanyl group was associated with a higher propofol dose per body weight per minutes.