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COMPARATIVE ANALYSIS OF THE EFFICACY OF PROPOFOL/KETAMINE COMBINATION VERSUS PROPOFOL ALONE FOR SEDATION IN FEMALE PATIENTS UNDERGOING BREAST BIOPSY UNDER LOCAL ANAESTHESIA
ABSTRACT
BACKGROUND
The choice of local anaesthesia technique by patients for minor surgical procedures is on the
increase. Patients are more satisfied when appropriate sedation is provided for them when
undergoing breast biopsy under local anaesthesia. The aim of the study was to compare the efficacy
of propofol and propofol/ketamine combination in providing sedation in patients scheduled for
breast biopsies under local anaesthesia.
PATIENTS AND METHODS
Following the approval of the University of Ilorin Teaching Hospital Ethical Review Committee,
70 consenting female patients scheduled for elective breast biopsy under local anaesthesia were
recruited into the study. They were randomly grouped into 2, each group consisting of 35 patients.
They all received bolus dose of either propofol or propofol/ketamine combination using the Sk
500 I syringe pump at dose of 500mcg/kg/min (This dose is in reference to propofol component
of the study drugs) for 3-5 minutes. This was done to achieve a conscious sedation corresponding
to Ramsay sedation score of 3 before the surgeon infiltrated the operation site with lidocaine.
Patient’s response to needle puncture was evaluated for discomfort using grimace for presence of
discomfort and no grimace for absence of discomfort. Patients’ baseline blood pressures (BP),
heart rate (HR) and the sedation scores were recorded. The BP and HR were also recorded every
5 minutes intraoperatively. Intraoperatively, sedation was maintained by continuous infusion of
the study drugs using the SK- 500 I syringe pump at incremental dose of 25mcg/kg/minute (This
dose is in reference to propofol component of the study drugs). The sedation infusion rate was
varied to maintain a conscious sedation equivalent to Ramsay sedation score of 3. The total dose
of the study drugs was recorded. In the post anaesthesia care unit (PACU), Patients’ satisfaction
with anaesthetic management, intraoperative discomfort (Using 100mm visual analogue scale),
presence of postoperative nausea and vomiting (PONV) and discharge time from PACU were
assessed and recorded.
RESULTS
The desired level of sedation (Ramsay sedation score of 3) was achieved in all the patients in
propofol/ketamine group while one patient in propofol group drifted to Ramsay sedation score of
4 intraoperatively during the study. Patient’s response to the insertion of needle for local
anaesthetic infiltration, assessed by grimace, was recorded in higher number of patients in propofol
group, 20 (57.1%) patients in propofol group compared with 1 (2.9%) patients in
ketamine/propofol group (p= 0.000). In the propofol group, 3(8.5%) had intraoperative
hypotension while there was no such occurrence in the propofol/ketamine group (p=0.031).
Patients’ satisfaction with anaesthetic management was similar in the 2 groups (p=0.201). In the
propofol group, 13(37.1%) were very satisfied, 17(48.6%) were satisfied and 5 (14.3%) were
somewhat satisfied. In propofol/ketamine group 9 (25.7%) were very satisfied, 24 (68.6%) were
satisfied and 2 (5.7%) were somewhat satisfied (p=0.201). Intraoperative discomfort as measured
by VAS using 100mm horizontal scale in the two groups was as follow: In propofol group; 10mm
in 16 (45.7%), 20mm in 14 (40%), 30mm in 2 (5.7%) and 40mm in 3 (8.6%) patients. In
propofol/ketamine group, 10mm in 9 (25.7%), 20mm in 22 (62.9%), 30mm in 2(5.7%) and 40mm
in 2 (5.7%) patients, (p=0.268).
Mean total dose requirement of propofol for maintenance of intraoperative sedation was
114±21.82mcg/kg/min in propofol group and 60.86±10.82mcg/kg/min in propofol/ketamine
group (p=0.001). This dose of drug was standardized against intraoperative sedation level
equivalent to Ramsay sedation score 3. There were 4 (11.43%) patients with PONV in
propofol/ketamine group but none in propofol group (P=0.039).
Finally, the mean time of discharge from PACU for patients in propofol group was
29±6.04minutes and 40±5.02minutes for propofol/ketamine group (p=0.000).
CONCLUSION
This study found that propofol or propofol/ketamine combination could be used to provide
conscious sedation (Ramsay sedation score 3) in patients scheduled for breast biopsy under local
anaesthesia. Addition of ketamine to propofol produced haemodynamic stability intraoperatively,
reduced patients’ response to needle puncture. However it was responsible for prolonged stay in
PACU and postoperative nausea and vomiting. Patient’s satisfactions in both propofol and
propofol/ketamine sedation were comparable.
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