Comparative efficacy and safety of ciprofol and propofol in hysteroscopy: A systematic review and meta-analysis of randomized controlled trials

Abstract Background and Aims: Hysteroscopy is a common gynecological procedure requiring reliable sedation to ensure patient comfort during cervical dilation and endometrial manipulation. Propofol is frequently chosen for its rapid onset and ease of titration but is linked to complications including injection pain, hypotension, and respiratory depression. Ciprofol, a newer propofol analog, may provide similar anesthetic performance with fewer side effects. This meta-analysis aims to compare the clinical effectiveness and risk profile of ciprofol with those of propofol in hysteroscopic sedation. Material and Methods: This present review was designed and structured in compliance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses framework. We included randomized controlled trials that compared ciprofol with propofol for sedation during hysteroscopy. A comprehensive search was carried out in PubMed, Scopus, Web of Science, and the Cochrane Library, encompassing research available through July 2025. The primary outcome was the success rate of hysteroscopy, while secondary outcomes included the time required for induction and recovery, and safety-related events such as injection pain, episodes of hypotension or hypoxemia, and body movements that interfered with the procedure. Study quality was assessed using the Cochrane Risk of Bias 2 tool. Results: Six trials involving 1,768 patients (882 ciprofol; 886 propofol) met inclusion criteria. Ciprofol provided equivalent efficacy and similar induction and recovery times. It correlated with a decrease in the incidence of pain during injection (mean difference (MD) = O.O8, 95% confidence interval (CI) [0.03,0.20], P < 0.00001), hypotension (MD = 0.44, 95% CI [0.35, 0.54, P < 0.00001), hypoxemia (odds ratios (OR) = 0.34, 95% CI [0.24, 0.48], P < 0.00001), and body movement (OR = 0.62, 95% CI [0.23, 1.72], P = 0.36). Conclusion: Ciprofol matches propofol’s performance while reducing key adverse effects, making it a potentially safer option for older or medically fragile patients. Larger multicenter trials and cost-effectiveness studies are needed to guide clinical practice.