Remifentanil versus Fentanyl/Midazolam in Painless Reduction of Anterior Shoulder Dislocation; a Randomized Clinical Trial
学术急诊医学档案,
卷 4 编号 2 (2016),
1 五月 2016
,
第 92-96 页
https://doi.org/10.22037/aaem.v4i2.227
摘要
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
##submission.howToCite##
参考
Cordell WH, Keene KK, Giles BK, Jones JB, Jones JH,
Brizendine EJ. The high prevalence of pain in emergency
medical care. The American journal of emergency
medicine. 2002;20(3):165–9.
Godwin SA, Caro DA, Wolf SJ, et al. Clinical policy: procedural
sedation and analgesia in the emergency department.
Annals of emergencymedicine. 2005;45(2):177–96.
Marx J, Walls R, Hockberger R. Rosen’s Emergency
Medicine-Concepts and Clinical Practice: Elsevier
Health Sciences; 2013. p.
Chalidis B, Sachinis N, Dimitriou C, Papadopoulos P,
Samoladas E, Pournaras J.Has themanagement of shoulder
dislocation changed over time? International orthopaedics.
;31(3):385–9.
Fitch RW, Kuhn JE. Intraarticular lidocaine versus intravenous
procedural sedation with narcotics and benzodiazepines
for reduction of the dislocated shoulder:
a systematic review. Academic Emergency Medicine.
;15(8):703–8.
Mace SE, Barata IA, Cravero JP, et al. Clinical policy:
evidence-based approach to pharmacologic agents
used in pediatric sedation and analgesia in the emergency
department. Annals of emergency medicine.
;44(4):342–77.
Panzer O, Moitra V, Sladen RN. Pharmacology of
sedative-analgesic agents: dexmedetomidine, remifentanil,
ketamine, volatile anesthetics, and the role
of peripheral mu antagonists. Anesthesiology clinics.
;29(4):587–605.
Scott L, Perry M. Remifentanil: A review of its use during
the induction and maintenance of general anaesthesia
(vol 65, pg 1793, 2005). DRUGS. 2005;65(16):2286.
Glass PS, Gan TJ, Howell S. A review of the pharmacokinetics
and pharmacodynamics of remifentanil. Anesthesia
& Analgesia. 1999;89(4S):7.
Dunn M, Mitchell R, Souza C, Drummond G. Evaluation
of propofol and remifentanil for intravenous sedation for
reducing shoulder dislocations in the emergency department.
Emergency medicine journal. 2006;23(1):57–8.
Dunn MJ,Mitchell R, DeSouza CI, Drummond GB,Waite
A. Recovery from sedation with remifentanil and propofol,
compared with morphine and midazolam, for reduction
in anterior shoulder dislocation. EmergencyMedicine Journal. 2011;28(1):6–10.
Swann A, Williams J, Fatovich DM. Recall after procedural
sedation in the emergency department. Emergency
Medicine Journal. 2007;24(5):322–4.
Cok OY, Ertan A, BahadirM. Remifentanil versus fentanyl
in combination with midazolam for retrobulbar block in
cataract surgery. Saudi medical journal. 2008;29(4):544–
Litman RS. Conscious sedation with remifentanil and
midazolam during brief painful procedures in children.
Archives of pediatrics & adolescent medicine.
;153(10):1085–8.
Rai M, Parry T, Dombrovskis A, Warner O. Remifentanil
target-controlled infusion vs propofol target-controlled
infusion for conscious sedation for awake fibreoptic intubation:
a double-blinded randomized controlled trial.
British journal of anaesthesia. 2008;100(1):125–30.
Phillips WJ, Halpin J, Jones J, McKenzie K. Remifentanil
for procedural sedation in the emergency department.
Annals of emergency medicine. 2009;53(1):163.
Sacchetti A, Jachowski J, Heisler J, Cortese T. Remifentanil
use in emergency department patients: initial experience.
EmergencyMedicine Journal. 2012;29(11):928–9.
Mamula P, Markowitz JE, Neiswender K, et al. Safety of
intravenous midazolam and fentanyl for pediatric GI endoscopy:
prospective study of 1578 endoscopies. Gastrointestinal
endoscopy. 2007;65(2):203–10.
- 摘要 ##plugins.themes.ojsPlusA.frontend.article.viewed##: 399 ##plugins.themes.ojsPlusA.frontend.article.times##
- PDF (English) ##plugins.themes.ojsPlusA.frontend.article.downloaded##: 211 ##plugins.themes.ojsPlusA.frontend.article.times##
- HTML (English) ##plugins.themes.ojsPlusA.frontend.article.downloaded##: 35 ##plugins.themes.ojsPlusA.frontend.article.times##
