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

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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/m 2 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 SpO 2 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. Keywords: oxycodone, propofol, conscious analgesia, elderly obese patients, gastroscopy

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