An Oxycodone-Based Conscious Analgesia Strategy with Supplemental Low-Dose Propofol Improves Safety in Elderly Obese Patients Undergoing Gastroscopy: A Prospective Randomized Controlled Trial

Abstract

Background During diagnostic gastroscopy, intolerance is usually manifested as retching, coughing, and involuntary movement. Conscious analgesia relieves discomfort while patients continue to breathe spontaneously and remain partly responsive. Oxycodone, a semi-synthetic opioid, may reduce the need for deep propofol sedation. We compared an oxycodone-based conscious analgesia strategy with supplemental low-dose propofol with propofol-based deep sedation in elderly obese patients. Patients and Methods In this prospective, single-center, open-label randomized controlled trial, 128 patients aged ≥65 years with a body mass index of 30–39.9 kg/m2 undergoing elective gastroscopy were randomized 1:1 to propofol-based deep sedation (group P) or oxycodone-based conscious analgesia with supplemental low-dose propofol (group OP). The primary outcome was the incidence of hypoxemia, defined as any SpO2 reading <90% during the procedure. Key secondary outcomes were airway interventions, hypotension, propofol consumption, and recovery time. Results All 128 randomized patients completed the study. Hypoxemia occurred less frequently in group OP than in group P (10.94% vs 37.50%; relative risk, 0.29; 95% CI, 0.14–0.63; P<0.001). Group OP also required fewer airway interventions (10.94% vs 37.50%; P<0.001), and mask-assisted ventilation was required less often (1.56% vs 32.81%; P<0.001). Hypotension was less frequent (9.38% vs 28.13%; P=0.012), total propofol consumption was lower (0.38±0.13 vs 1.70±0.25 mg/kg; P<0.001), and time to full wakefulness was shorter (3.89±0.73 vs 8.21±1.12 minutes; P<0.001) in group OP. Conclusion Compared with propofol-based deep sedation, the oxycodone-based conscious analgesia strategy was associated with a lower incidence of hypoxemia, fewer airway interventions, less hypotension, lower propofol exposure, and faster recovery. These findings reflect a comparison of two sedation strategies and do not establish improved respiratory function.