# Comparing the Effectiveness and Safety of Giving Fentanyl or Ketamine Intranasally during Phacoemulsification Surgery

## TL;DR

This study compared intranasal ketamine and fentanyl for sedation and pain relief during cataract surgery, finding both drugs similarly effective with no major differences in outcomes.

## Contribution

The study provides a direct comparison of intranasal ketamine and fentanyl for sedation and analgesia in phacoemulsification surgery.

## Key findings

- INK showed a higher percentage of patients with no pain compared to INF.
- Both drugs achieved similar levels of optimal sedation and had comparable side effects.
- No significant differences were found in hemodynamic parameters or patient satisfaction between the two groups.

## Abstract

Background:Phacoemulsification is the main method of cataract surgery in
developed countries. Due to the importance of appropriate analgesia and the
immobility of the participants throughout the procedure, the study aimed to
assess the impact of intranasal ketamine vs. intranasal fentanyl on the quality
of sedation and analgesia in phacoemulsification surgery. Materials and Methods:
This double-blinded study was carried out on participants who underwent cataract
surgery in Faiz Hospital, Isfahan, Iran. Eighty subjects were randomly assigned
to two groups of 40 receiving ketamine at a dosage of 1.5 mg/kg intranasally
(Intranasal Ketamine (INK) group) or fentanyl at 1.5 μg/kg nasally (Intranasal
Fentanyl (INF) group). The drugs were administered through the nasal passage 15
minutes before the operation. The primary outcomes were a difference in the
quality of sedation and pain relief between groups during the procedure and
recovery unit. Secondary outcomes were cardiovascular parameters, side effects,
the need for sedative rescues, and changes in vital signs. Results:During the
study, 25 patients (62.5%) in the INK cohort and 19 patients (47.5%) in the INF
cohort had no pain. In the INK group, 22 (55%) and in the INF group 20 (50.0%)
patients achieved optimal sedation (Ramsay sedation score 4). There was no
discernible disparity observed between the two cohorts in terms of the quality
of sedation (P=0.071), receipt of rescue dosage of propofol (P=0.601),
hemodynamic parameters (P0.05), and side effects during treatment Operation
(P=0.542) and in recovery (P=0.104), patient (P=0.098) and surgeon (P=0.120)
satisfaction, operative time (P=0.082), and duration of stay in recovery
(P=0.110). Conclusion: Although INK was more effective than INF in reducing pain
and achieving optimal sedation in cataract surgery, it was not significantly
superior to INF.