Abstract
The aim of the present study was to investigate two pharmaceutical groups including fentanyl-midazolam and midazolam-ketamine used as patient seda-tion analgesia for the orthopedic emergency procedures. This is a prospective randomized double-blind and placebo-controlled trial study. Trauma patients admitted to emergency department who needed emergency reduction were enrolled. Finally 81 patients with mean age of 31.7 ± 20.6 years old were participated (64.2% male). It is likely that the combination of midazolam-ketamine had a better performance in terms of the duration of hypoxia (p=0.01), and pain scores during reduction (p=0.001). However, adverse effects were higher in the midazolam-ketamine group compared to the fentanyl-midazolam. The level of satisfaction of physicians and patients were the same.
Highlights
Orthopedic reductions are among the most prevalent procedures in the Emergency Department
Of 488 patients admitted to the Emergency Department with limb injuries that required emergency closed reduction, 141 patients were evaluated for inclusion in the study, 60 of whom were excluded
The adverse effects were higher in the midazolamketamine groups compared to the fentanyl-midazolam group
Summary
Orthopedic reductions are among the most prevalent procedures in the Emergency Department. According to the American Emergency Physicians Association guideline 2005, Procedural Sedation and Analgesia (PSA) has been defined for the utilization of dissociative or sedative agents with or without analgesics during the painful procedures, provided that the performance of cardiorespiratory system is maintained (Baratloo et al, 2016; Bordo et al, 2008). One of the recommendations to reduce the adverse effects of medications for PSA, is the use of drug combinations. The use of drug combinations, together with lowering the dose of drugs can compare with monotherapy and prevent the occurrence of adverse effects (Cevik et al, 2013)
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