Comparison of Ketamine-Dexmedetomidine Combination with Fentanyl-Dexmedetomidine Combination for Procedural Sedoanalgesia during CT-Guided Interventional Radiology Procedures: A Randomized Controlled Study

Abstract

Background: The quest for an ideal sedoanalgesic-combination exhibiting the triad of efficacy, safety and patient comfort has led to administration of several permutations and combinations of drugs (midazolam, fentanyl, remifentanil, dexmedetomidine, propofol, ketamine, pethidine, pentazocine). The ideal sedoanalgesic for CT-guided core-biopsy of spine, radiofrequency/microwave ablation of hepatic/pulmonary lesions, has hitherto been elusive. In the absence of any guidelines, we compared a ketamine-dexmedetomidine combination (Group-K) with fentanyl-dexmedetomidine (Group-F). Methods: This prospective, interventional, single-centric, parallel-armed, randomized controlled study included 60 patients (ASA physical state I-II, either gender, aged 18-75y, weighing 35-85kg), undergoing CT-guided core biopsy/radiofrequency/microwave ablation in remote location, allocated to Group-K and Group-F. Independent/paired-sample t-tests were utilized and data expressed as box-whisker plots and trendlines, p-value<0.05 being statistically significant. Results: There was a significant difference in intraprocedural pain-scores between both groups (p-values 0.0001, 0.0011, 0.0092 and 0.0201 at 0-10mins, 10-20mins, 20-30mins and 30-40mins respectively). More patients in Group-F required rescue-analgesic with reduced interventionist-satisfaction score versus Group-K. In Group-K, mean arterial pressure and heart rate (95.1mmHg;79.6/min) increased after initial ketamine bolus, but were maintained/decreased at intervention-initiation (93.2mmHg;79.4/min) and at 10min and 30min thereafter. In Group-F, MAP and HR decreased after initial fentanyl bolus (83.5mHg;71.9/min), increased with intervention-initiation (90.1mmHg;77/min), progressively decreasing at every time-point thereafter. VAS-scores (resting; on coughing) were lower in Group-K. Conclusion: A ketamine-dexmedetomidine combination technique demonstrated a superior sedoanalgesic effect with reduced intra-procedural bradypnea, bradycardia, rescue-drug requirement and post-procedural complications with enhanced interventionist-satisfaction and may emerge as the ideal procedural sedoanalgesic for patients undergoing CT-guided core-biopsy, radiofrequency/microwave ablation.

Keywords

• Dexmedetomidine
• Fentanyl
• Interventional radiology
• Ketamine
• Procedural sedation
• Remote location