Comparison of the Effect of Ketofol and Ketodex as Procedural Sedation and Analgesia for Oocyte Retrieval during In...

Oocyte retrieval requires effective sedation that ensures patient comfort without compromising reproductive outcomes. Although multiple sedative agents are routinely employed during oocyte retrieval, the optimal sedative regimen remains an active research area.

The aim of this study was to compare the analgesic efficacy and safety of Ketodex (ketamine-dexmedetomidine) versus Ketofol (ketamine-propofol) for procedural sedation for oocyte retrieval during in vitro fertilisation (IVF) procedures.

Double blinded, single-centre, randomised controlled pilot study at a tertiary-care IVF centre.

Sixty American Society of Anesthesiologists I-II women (20-40 years) scheduled for transvaginal oocyte retrieval were randomised to receive Ketofol (ketamine + propofol) or Ketodex (ketamine + dexmedetomidine) (n = 30/group). The primary outcome was to determine the mean pain scores during oocyte retrieval and within the first 2 h post-procedure by using the Visual Analogue Scale (VAS). Rescue analgesia (fentanyl) and peri-procedural adverse events were recorded. Embryological outcomes included fertilisation and cleavage rates. An exploratory cumulative pain score (CPS), integrating early pain burden with opioid requirement, was also analysed.

Two-group comparison was done with the Mann-Whitney U-test (non-normal data) and independent t-test (normal data). For comparing repeated measures of pain scores over time within groups, the Friedman test was employed.

VAS scores decreased over time in both groups, but were significantly lower in the Ketodex group at all post-operative time points (10 min; 30 min; 1 h; 2 h, P < 0.001). Intraoperative fentanyl requirement was significantly higher with Ketofol compared with Ketodex (median 20.67 μg vs. 0 μg; P < 0.001). Apnoea occurred in 53.3% of Ketofol patients and in none of the Ketodex patients (P < 0.001). Fertilisation rates and cleavage rates were comparable between groups. Exploratory CPS was significantly lower in the Ketodex group (P < 0.001).

Ketodex demonstrated superior analgesic efficacy, opioid sparing and improved safety compared to Ketofol.