Comparison of Propofol and Ketamine Combination (Ketofol) and Propofol and Fentanyl Combination (Fenofol) on Quality of Sedation and Analgesia in the Lumpectomy: A Randomized Clinical Trial

Document Type : Original Article


1 Department of Anesthesiology and Critical Care, Anesthesiology and Critical Care Research Center, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

2 Department of Anesthesiology, Kurdistan University of Medical Sciences, Sanandaj, Iran

3 Medical School, Isfahan University of Medical Sciences, Isfahan, Iran


Background: Breast lumpectomy is an integral part of the treatment of mammary masses in women. This study was conducted to evaluate and compare two-drug combinations of propofol–ketamine (PK) (ketofol) and propofol–fentanyl (PF) (fenofol) on quality of sedation and analgesia in lumpectomy. Materials and Methods: This was a randomized, double-blind, clinical trial performed on 64 patients aged 15–70 years with breast cancer lumpectomy referred to Isfahan's Seyed Al-Shohada Hospital. Consequently, patients were divided into two groups of 32 patients, each group receiving PF combination or PK combination during anesthesia. Results: The patients in two groups, PF and PK, were compared in their sedation levels, severity of pain, and other variables. The mean arterial blood pressure, systolic blood pressure, and heart rate (HR) did not show any significant difference at the beginning of the study in the two groups, but the fenofol (PF) group had a significantly lower oxygen saturation than the ketofol (PK) group. The sedation level was significantly lower in the fenofol group than the ketofol group (P < 0.001). The mean pain intensity was significantly lower in the PF group than the PK group (P < 0.001). Conclusion: The two combinations of ketofol and fenofol cause rapid, favorable, safe anesthetic with minimal side effects and hemodynamic effects but it may be a superior alternative to fenofol combination, in terms of respiratory depression.


Fassoulaki A, Melemeni A, Staikou C, Triga A, Sarantopoulos C. Acute postoperative pain predicts chronic pain and long-term analgesic requirements after breast surgery for cancer. Acta Anaesthesiol Belg 2008;59:241-8.  Back to cited text no. 1
Fisher B, Anderson S, Bryant J, Margolese RG, Deutsch M, Fisher ER, et al. Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med 2002;347:1233-41.  Back to cited text no. 2
Arora S. Combining ketamine and propofol (“ketofol”) for emergency department procedural sedation and analgesia: A review. West J Emerg Med 2008;9:20-3.  Back to cited text no. 3
Singh Bajwa SJ, Bajwa SK, Kaur J. Comparison of two drug combinations in total intravenous anesthesia: Propofol-ketamine and propofol-fentanyl. Saudi J Anaesth 2010;4:72-9.  Back to cited text no. 4
Singh R, Ghazanwy M, Vajifdar H. A randomized controlled trial to compare fentanyl-propofol and ketamine-propofol combination for procedural sedation and analgesia in laparoscopic tubal ligation. Saudi J Anaesth 2013;7:24-8.  Back to cited text no. 5
[PUBMED]  [Full text]  
Chidambaran V, Costandi A, D'Mello A. Propofol: A review of its role in pediatric anesthesia and sedation. CNS Drugs 2015;29:543-63.  Back to cited text no. 6
Burton JH, Miner JR, Shipley ER, Strout TD, Becker C, Thode HC Jr., et al. Propofol for emergency department procedural sedation and analgesia: A tale of three centers. Acad Emerg Med 2006;13:24-30.  Back to cited text no. 7
Dunn T, Mossop D, Newton A, Gammon A. Propofol for procedural sedation in the emergency department. Emerg Med J 2007;24:459-61.  Back to cited text no. 8
Miner JR, Biros M, Krieg S, Johnson C, Heegaard W, Plummer D, et al. Randomized clinical trial of propofol versus methohexital for procedural sedation during fracture and dislocation reduction in the emergency department. Acad Emerg Med 2003;10:931-7.  Back to cited text no. 9
Miner JR, Danahy M, Moch A, Biros M. Randomized clinical trial of etomidate versus propofol for procedural sedation in the emergency department. Ann Emerg Med 2007;49:15-22.  Back to cited text no. 10
Akin A, Esmaoglu A, Guler G, Demircioglu R, Narin N, Boyaci A, et al. Propofol and propofol-ketamine in pediatric patients undergoing cardiac catheterization. Pediatr Cardiol 2005;26:553-7.  Back to cited text no. 11
Marx CM, Stein J, Tyler MK, Nieder ML, Shurin SB, Blumer JL, et al. Ketamine-midazolam versus meperidine-midazolam for painful procedures in pediatric oncology patients. J Clin Oncol 1997;15:94-102.  Back to cited text no. 12
Gelen SA, Sarper N, Demirsoy U, Zengin E, Çakmak E. The efficacy and safety of procedural sedoanalgesia with midazolam and ketamine in pediatric hematology. Turk J Haematol 2015;32:351-4.  Back to cited text no. 13
Hashemi AS, Ayatolahi V, Ghilian R, Ghadami Yazdi A, Fadavi N, Yadegar Y, et al. Ketofol for bone marrow aspiration and lumbar puncture in children with ALL. Iran J Pediatr Hematol Oncol 2011;1:126-32.  Back to cited text no. 14
Aouad MT, Moussa AR, Dagher CM, Muwakkit SA, Jabbour-Khoury SI, Zbeidy RA, et al. Addition of ketamine to propofol for initiation of procedural anesthesia in children reduces propofol consumption and preserves hemodynamic stability. Acta Anaesthesiol Scand 2008;52:561-5.  Back to cited text no. 15
Stanley TH, Berman L, Green O, Robertson D. Plasma catecholamine and cortisol responses to fentanyl – Oxygen anesthesia for coronary-artery operations. Anesthesiology 1980;53:250-3.  Back to cited text no. 16
Hollman GA, Schultz MM, Eickhoff JC, Christenson DK. Propofol-fentanyl versus propofol alone for lumbar puncture sedation in children with acute hematologic malignancies: Propofol dosing and adverse events. Pediatr Crit Care Med 2008;9:616-22.  Back to cited text no. 17
Khutia SK, Mandal MC, Das S, Basu SR. Intravenous infusion of ketamine-propofol can be an alternative to intravenous infusion of fentanyl-propofol for deep sedation and analgesia in paediatric patients undergoing emergency short surgical procedures. Indian J Anaesth 2012;56:145-50.  Back to cited text no. 18
[PUBMED]  [Full text]  
Akin A, Guler G, Esmaoglu A, Bedirli N, Boyaci A. A comparison of fentanyl-propofol with a ketamine-propofol combination for sedation during endometrial biopsy. J Clin Anesth 2005;17:187-90.  Back to cited text no. 19
Kb N, Cherian A, Balachander H, Kumar C Y. Comparison of propofol and ketamine versus propofol and fentanyl for puerperal sterilization, A randomized clinical trial. J Clin Diagn Res 2014;8:GC01-4.  Back to cited text no. 20