IV Ketamine as good as Fentanyl for procedural sedation in first Trimester surgical abortion

A recent study found that IV ketamine is non-inferior to IV Fentanyl in patient satisfaction with anesthesia when used for procedural sedation during the first-trimester outpatient surgical abortion. The study was published in the journal 'Obstetrics and Gynecology.'

Ketamine is used very commonly for procedural sedation and analgesia for trauma cases. There is very little research on the use of ketamine for surgical abortions. Hence, researchers conducted a trial to assess patient satisfaction with IV Ketamine vs IV Fentanyl anesthesia after the first trimester of surgical abortion for procedural sedation. A randomized noninferiority trial was conducted on pregnant women undergoing surgical abortion up to 13 6/7 weeks of gestation. Participants were randomized to receive either ketamine 200–500 micrograms/kg IV over 2 minutes, repeated every 5 minutes until appropriate analgesia was achieved, or fentanyl 0.5–1 microgram/kg IV over 2 minutes, repeated every 5 minutes until appropriate analgesia was achieved. All patients were given midazolam 2 mg IV. Patient satisfaction was the primary outcome which was measured using the Iowa Satisfaction with Anesthesia Scale immediately post-procedure. Postoperative pain, additional pain medication necessary during the procedure and on discharge, physician satisfaction, and time to discharge were the Secondary outcomes. 

Results:

• The study was conducted from April to October 2021.
• 184 patients were screened and 110 were randomized. Out of which 57 were subjected to ketamine and 53 to fentanyl.
• Demographics were similar between groups.
• Patient satisfaction with anesthesia, which is the primary outcome, was non-inferior in the ketamine group as compared with the fentanyl group with a risk difference of 0.20.
• More hallucinations were reported in the ketamine group.
• Secondary outcomes were similar between the groups. 

Thus, the researchers concluded that IV ketamine is non-inferior for patient satisfaction with anesthesia when used for procedural sedation for first-trimester outpatient surgical abortion when compared with IV fentanyl. 

For the full article, click here: 10.1097/AOG.0000000000004903 

Chin J, McGrath M, Lokken E, Upegui CD, Prager S, Micks E. Ketamine Compared With Fentanyl for Surgical Abortion: A Randomized Controlled Trial [published online ahead of print, 2022 Aug 3]. Obstet Gynecol. 2022;10.1097/AOG.0000000000004903.