Comparison of the Effectiveness of Propofol-Remifentanil and Propofol-Fentanyl for Procedural Sedation During Endoscopic Retrograde Cholangiopancreatography

Open Access

Abstract

Background: Endoscopic retrograde cholangiopancreatography (ERCP) is a technically challenging procedure that demands effective procedural sedation for patient comfort and procedural success. This study aimed to compare the efficacy of propofol-remifentanil (Group R) and propofol-fentanyl (Group F) combinations for sedation during ERCP. Methods & Materials: This prospective, comparative study was conducted at Dhaka Medical College Hospital from April 2023 to October 2024. 50 adult patients (ASA I-II) who were undergoing elective ERCP were randomly divided into two groups of 25 patients. Both groups were given a loading dose of 1.5 mg/kg of propofol, with Group F being given a fentanyl 1 mcg/kg bolus and Group R being given a remifentanil infusion of 0.05 mcg/kg/min. Haemodynamic parameters, sedation (Ramsay Sedation Scale), pain (Facial Pain Rating Scale), drug requirements, recovery time, and adverse events were recorded. Data were entered and analyzed using IBM SPSS version 26. Results: Demographic and baseline characteristics were similar between the two groups. Heart rate and mean arterial pressure were significantly lower in group R in the procedural phases (p<0.05). Group R also had deeper sedation at T2 (RSS: 5.1 vs 3.1, p=0.001) and had significantly lower pain scores throughout (p<0.05). Total propofol consumption (180.5 vs 213.3 mg, p=0.026), rescue analgesia requirement (3.0 vs 15.0 mg, p=0.013), recovery time (8.9 vs 12.8 min, p=0.001), and time to discharge (65.7 vs 78.4 min, p=0.002) were significantly lower in Group R. Adverse event rates were similar between groups. Conclusion: Propofol-remifentanil combination is more effective and clinically useful for procedural sedation in ERCP, offering superior sedation quality, better analgesia, reduced propofol consumption, and faster recovery.