A Randomized Controlled Trial Comparing Propofol-Dexmedetomidine versus Propofol-Fentanyl Combinations for Sedation in Endoscopic Retrograde Cholangio-Pancreatography (ERCP) Procedures

Open Access

Abstract

Background: Endoscopic retrograde cholangiopancreatography (ERCP) requires effective sedation for patient comfort and procedural safety. Propofol provides rapid sedation but may cause respiratory depression and hypotension, while fentanyl provides analgesia with cardiorespiratory risks. Dexmedetomidine offers sedation and analgesia with minimal respiratory depression but may cause bradycardia and hypotension. This randomized controlled trial compares propofol-dexmedetomidine with propofol-fentanyl for sedation efficacy, safety, recovery, and patient satisfaction during ERCP. Methods & Materials: This randomized controlled trial enrolled 90 adults undergoing ERCP, randomized equally to propofol-dexmedetomidine or propofol-fentanyl. Sedation efficacy, cardiorespiratory stability, propofol use, recovery, adverse events, and patient satisfaction were assessed. Data were analyzed using SPSS version 23, with p<0.05 considered significant. Results: Ninety patients completed the study, with 45 in each group. Baseline characteristics were comparable (p>0.05). Propofol-dexmedetomidine significantly reduced total propofol requirement (82.4 ± 21.6 vs. 103.7 ± 25.8 mg; p<0.001) and recovery time (12.8 ± 4.1 vs. 16.4 ± 5.3 min; p<0.001). Minimum oxygen saturation was higher (94.8 ± 2.3% vs. 92.9 ± 3.1%; p=0.002), with fewer oxygen desaturation (11.1% vs. 28.9%; p=0.042), airway interventions (6.7% vs. 22.2%; p=0.048), and prolonged recovery (4.4% vs. 20.0%; p=0.023). Patient satisfaction was higher (8.6 ± 1.1 vs. 7.8 ± 1.4; p=0.004). Bradycardia was more frequent with dexmedetomidine but not significant. Other outcomes were comparable. Conclusion: Propofol-dexmedetomidine provided effective ERCP sedation with lower propofol requirements, faster recovery, better oxygenation, fewer respiratory adverse events, and higher patient satisfaction than propofol-fentanyl. It may therefore be a preferable sedation option for ERCP, with appropriate monitoring for bradycardia.