Remifentanil versus Fentanyl/Midazolam in Painless Reduction of Anterior Shoulder Dislocation; a Randomized Clinical Trial
Archives of Academic Emergency Medicine,
Vol. 4 No. 2 (2016),
1 May 2016
,
Page 92-96
https://doi.org/10.22037/aaem.v4i2.227
Abstract
Introduction: Performance of painful diagnostic and therapeutic procedures is common in emergency department(ED), and procedural sedation and analgesia (PSA) is a fundamental skill for every emergency physician.
This studywas aim to compare the efficacy of remifentanil with fentanyl/midazolam in painless reduction of anterior
shoulder dislocation. Methods: In this randomized, double blind, clinical trial the procedural characteristics,
patients satisfaction as well as adverse events were compared between fentanyl/midazolamand remifentanil
for PSA of 18–64 years old patients, which were presented to ED following anterior shoulder dislocation.
Results: 96 cases were randomly allocated to two groups (86.5% male). There were no significant difference between
groups regarding baseline characteristics. Remifentanil group had lower duration of procedure (2.5§1.6
versus 4.6§1.8 minutes, p Ç 0.001), higher pain reduction (53.7§13.3 versus 33.5§19.6, p Ç 0.001), lower failure
rate (1 (2.1%) versus 15 (31.3%), p Ç 0.001), higher satisfaction (p Æ 0.005). Adverse events were seen in 12 (25%)
patients in midazolam/fentanyl and 8 (16.7%) cases in remifentanil group (p Æ 0.122). Conclusion: It seems
that use of remifentanil resulted in lower procedural time, lower failure rate, and lower pain during procedure
as well as higher patient satisfaction in comparison with midazolam/fentanyl combination in anterior shoulder
dislocation.
- Conscious sedation
- midazolam
- fentanyl
- remifentanil [supplementary concept]
- shoulder dislocation
How to Cite
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