Opioid-Sparing Sedation for Gastrostomy Tube Placement: A Retrospective Cohort Study Comparing Ketamine/Midazolam and Fentanyl/Midazolam.
TL;DR
Ketamine/midazolam was associated with reduced postoperative analgesic requirements and comparable observed safety for gastrostomy tube placement, suggesting ketamine/midazolam was associated with reduced postoperative analgesic requirements and comparable observed safety for gastrostomy tube placement.
Abstract
Percutaneous gastrostomy tube placement is associated with substantial procedural and postprocedural pain. This retrospective single-center sequential before-and-after cohort study compared fentanyl/midazolam versus ketamine/midazolam sedation for percutaneous gastrostomy placement between October 2022 and April 2026. Of 129 consecutive procedures screened, 30 were excluded, yielding 99 procedures performed with fentanyl/midazolam (n = 54) or ketamine/midazolam (n = 45). The primary outcome was a composite sedation/analgesia-related clinical outcome, including serious sedation-related events, oxygen desaturation <90%, postoperative analgesic use, or antiemetic administration. Ketamine/midazolam was associated with a lower rate of the composite clinical outcome compared with fentanyl/midazolam (40.0% vs 63.0%, p = .027), primarily driven by lower postoperative analgesic requirements. Trends favored ketamine for desaturation and serious sedation-related events, while antiemetic use, nadir systolic blood pressure, and Aldrete recovery scores were similar between groups. These findings suggest ketamine/midazolam was associated with reduced postoperative analgesic requirements and comparable observed safety for gastrostomy tube placement.