Opioid-Sparing Sedation for Gastrostomy Tube Placement: A Retrospective Cohort Study Comparing Ketamine/Midazolam and Fentanyl/Midazolam.

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.