Thiopental-Fentanyl versus Midazolam-Fentanyl for Emergency Department Procedural Sedation and Analgesia in Patients with Shoulder Dislocation and Distal Radial Fracture-Dislocation: A Randomized Double-Blind Controlled Trial
Background and aim: It has not been well studied whether fentanyl-thiopental (FT) is effective and safe for PSA in orthopedic procedures in Emergency Department (ED). The aim of this trial was to evaluate the effectiveness of intravenous FT versus fentanyl-midazolam (FM) in patients who suffered from shoulder dislocation or distal radial fracture-dislocation. Methods: In this randomized double-blinded study, Seventy-six eligible patients were entered the study and randomly received intravenous FT or FM. The success rate, onset of action and recovery time, pain score, physicians’ satisfaction and adverse events were assessed and recorded by treating emergency physicians. The statistical analysis was intention to treat. Results: The success rate after administrating loading dose in FT group was significantly higher than FM group (71.7% vs. 48.9%, p=0.04); however, the ultimate unsuccessful rate after 3 doses of drugs in the FT group was higher than the FM group (3 to 1) but it did not reach to significant level (p=0.61). Despite near equal onset of action time in two study group (P=0.464), the recovery period in patients receiving FT was markedly shorter than FM group (P<0.001). The occurrence of adverse effects was low in both groups (p=0.31). Conclusion: PSA using FT is effective and appears to be safe for orthopedic procedures in the ED. Therefore, regarding the prompt onset of action, short recovery period of thiopental, it seems that this combination can be considered more for performing PSA in orthopedic procedures in ED.
Digital Object Identifier (DOI): doi.org/10.5281/zenodo.1099142Procedia APA BibTeX Chicago EndNote Harvard JSON MLA RIS XML ISO 690 PDF Downloads 1782
 Godwin SA, Caro DA, Wolf SJ, et al. Clinical policy: procedural sedation and analgesia in the emergency department. Ann Emerg Med. 2005;45:177-196.
 Lee-Jayaram JJ, Green A, Siembieda J, Gracely EJ, Mull CC, Quintana E, Adirim T.Ketamine/midazolam versus etomidate/fentanyl: procedural sedation f or pediatric orthopedic reductions. PediatrEmerg Care. 2010 Jun; 26(6): 408-12.
 Doyle E.Emergency analgesia in the paediatric population. Part IV Paediatric sedation in the accident and emergency department: pros and cons.Emerg Med J. 2002 Jul;19(4):284-7
 Mantadakis E, Katzilakis N, Foundoulaki E, Kalmanti M.Moderate intravenous sedation with fentanyl and midazolam for invasive procedures in childrenwith acute lymphoblastic leukemia.J PediatrOncolNurs. 2009 Jul-Aug;26(4):217-22
 Pandey RK, Padmanabhan MY, Saksena AK, Chandra G.Midazolamfentanyl analgo-sedation in pediatric dental patients--a pilot study.J ClinPediatr Dent. 2010 Fall;35(1):105-10.
 Barriga J, Sachdev MS, Royall L, Brown G, Tombazzi CR.Sedation for upper endoscopy: comparison of midazolam versus fentanyl plus midazolam.South Med J. 2008 Apr;101(4):362-6
 Mandel JE, Tanner JW, Lichtenstein GR, Metz DC, Katzka DA, Ginsberg GG, Kochman ML.A randomized, controlled, double-blind trial of patient-controlled sedation with propofol/remifentanil versus midazolam/fentanyl for colonoscopy.AnesthAnalg. 2008 Feb;106(2):434-9
 Cok OY, Ertan A, Bahadir M.Comparison of midazolam sedation with or without fentanyl in cataract surgery.ActaAnaesthesiol Belg. 2008;59(1):27-32.
 Kennedy RM, Porter FL, Miller JP, Jaffe DM.Comparison of fentanyl/midazolam with ketamine/midazolam for pediatric orthopedic emergencies. Pediatrics. 1998 Oct;102(4 Pt 1):956-63.
 Pershad J, Todd K, Waters T.Cost-effective analysis of sedation and analgesia regimens during fracture manipulation in the pediatric emergency department. PediatrEmerg Care. 2006; 22(10): 729-36.
 American Society of Anesthesiologists: Physical Status Classification System. Available at: http://www.asahq.org/clinical/physicalstatus.htm. Accessed November 24, 2008.
 Green SM, Krauss B: Systemic Analgesia and Sedation for Procedures. In Roberts JR, Hedges JR (eds): Clinical Procedures in Emergency Medicine. Philadelphia, Saunders, 2010, pp 540-562
 Aldrete JA, Kroulik D. A postanesthetic recovery score. AnesthAnalg 1970; 49 (6): 924-34.
 American College of Emergency Physicians: Clinical policy for procedural sedation and analgesia in the emergency department. Ann Emerg Med May 1998;31:663-677.
 Trevor AJ, Katzung BG, Masters SB. Katzung& Trevor’s Pharmacology Examination & Board review. McGraw-Hill
 Hopson LR, Schwartz RB: Pharmacologic Adjuncts to Intubation. In Roberts JR, Hedges JR (eds): Clinical Procedures in Emergency Medicine. Philadelphia, Saunders, 2010, pp 99-109.
 Reitan JA, Porter W, Braunstein M. Comparison of psychomotor skills and amnesia after induction of anesthesia with midazolam or thiopental.AnesthAnalg. 1986 Sep;65(9):933-7.
 Sorensen MK, Dovlen TL, Rasmussen LS. Onset and hemodynamic response after thiopental vs. propofol in the elderly: a randomized trial. ActaAnaesthesiolScand 2001; 55(4):429-434.
 Innes G, Murphy M, Nijssen-Jordan C, Ducharme J, Drummond A.Procedural sedation and analgesia in the emergency department. Canadian Consensus Guidelines. J Emerg Med. 1999 Jan-Feb;17(1):145- 56.