Effect of a single dose of sufentanil as an adjunct to ketofol-based monitored anesthesia care for ambulatory surgery: A retrospective case-control study

Background and Aims: Ketofol, a combination of ketamine and propofol, is widely used for procedural sedation in monitored anesthesia care (MAC). While it provides analgesia and hemodynamic stability, it may be insufficient for painful procedures. Sufentanil, a potent opioid with rapid onset and moderate duration, may enhance analgesia in ketofol-based MAC. This study aimed to evaluate the efficacy and safety of adding single-dose sufentanil to ketofol in patients undergoing brief ambulatory gynecologic procedures under MAC. Materials and Methods: We retrospectively reviewed patients who received ketofol-based MAC with or without a single dose of sufentanil. Primary outcomes included postoperative pain scores at 0-1 and 1-6 h. Secondary outcomes included surgical condition scores, need for assisted ventilation, and incidence of postoperative nausea and vomiting (PONV). Results: Eighty patients were included (n = 40 per group). The sufentanil group had significantly lower pain scores in the first postoperative hour than did those of the ketofol-only group, with no difference in pain scores at 1-6 h. Surgical conditions were significantly better in the sufentanil group than in the ketofol-only group. However, assisted ventilation was more frequently required in the sufentanil group than in the ketofol-only group. PONV incidence was similar between groups. Conclusion: Adding a single dose of sufentanil to ketofol-based MAC improves early postoperative analgesia and enhances surgical conditions without prolonging the emergence time or increasing the incidence of PONV. However, it significantly increases the need for assisted ventilation, highlighting the importance of respiratory monitoring.