Patient Satisfaction of Propofol Versus Midazolam and Fentanyl Sedation During Colonoscopy in Pakphanang Hospital, Randomized Trial

Abstract

Background:  Colonoscopy is the standard method for diagnosing and treating colonic disorders. However, it can cause discomfort or pain to patients; therefore, sedation is commonly used to enhance cooperation and satisfaction. The commonly used agents include Propofol and the combination of Midazolam with Fentanyl, which have different pharmacological properties.

Objective: To compare patient satisfaction, pain level, and procedure time between Propofol alone and the combination of Midazolam with Fentanyl for sedation during colonoscopy in patients undergoing the procedure at Pak Phanang Hospital from October to April 2024.

Materials and Methods: This was a prospective, randomized, unblinded clinical trial involving 76 patients undergoing colonoscopy at Pak Phanang Hospital, Nakhon Si Thammarat Province. Patients were divided into two groups: Propofol sedation and Midazolam/Fentanyl sedation. Satisfaction level, pain score, procedure time, recovery time, and complications were assessed. Statistical analysis was performed using SPSS Version 16.

Results: A total of 76 patients were enrolled and evenly divided into the Propofol group and the Midazolam/Fentanyl group (38 patients each). There were no significant differences in age, sex, weight, or ASA classification between the groups. However, the Propofol group had a higher proportion of outpatients. Common comorbidities such as diabetes, hypertension, and dyslipidemia were similarly distributed across both groups. A history of previous abdominal surgery was present in a small number of patients, with no significant difference between groups. Regarding indications for colonoscopy, the Midazolam/Fentanyl group had a significantly higher proportion of patients with a positive FIT test, whereas abdominal pain was a significantly more common indication in the Propofol group. Most procedures were diagnostic colonoscopies, with some cases involving polypectomy or biopsy, with no significant difference between the two groups. For clinical outcomes, satisfaction scores were high in both groups and did not differ significantly. However, pain scores were significantly higher in the Midazolam/Fentanyl group compared with the Propofol group (mean 2.79 vs. 0, P<0.01). Sedation time, procedure duration, and recovery time showed no significant differences, and no complications were reported in either group.

Conclusion: Both Propofol and Midazolam/Fentanyl provide comparable patient satisfaction, but Propofol offers better pain control. The choice of sedative should be based on staff readiness, available equipment, and the healthcare setting context.