Dexmedetomidine-Fentanyl versus Midazolam-Fentanyl in Pain Management of Distal Radius Fractures Reduction; a Randomized Clinical Trial
EMERGENCY ,
Vol. 6 No. 1 (2018),
19 November 2017
,
Page e10
https://doi.org/10.22037/emergency.v6i1.19907
Abstract
Introduction: Currently, using various combinations of narcotic and analgesic drugs has received attention for induction of sedation and analgesia due to their synergy in controlling pain and anxiety. The present study was designed with the aim of comparing dexmedetomidine-fentanyl combination with midazolam-fentanyl in this regard. Methods: In this randomized clinical trial, patients diagnosed with distal radius fracture who had visited the emergency department (ED) were allocated to either the group receiving the combination of fentanyl-midazolam or the one receiving dexmedetomidine-fentanyl for procedural sedation and analgesia (PSA) and were compared regarding analgesic characteristics, time to recovery and side effects. Results: 80 patients with the mean age of 42.08 ± 12.17 (18 - 60) years were randomly allocated to 2 groups of 40 (83.80% male). The 2 groups did not have a significant difference regarding baseline characteristics as well as pain severity. Mean pain score at the time of procedure was 3.47 ± 1.37 in dexmedetomidine and 2.85 ± 1.05 in midazolam group (p = 0.025). In addition, time to recovery in dexmedetomidine and midazolam groups was 6.60 ± 1.86 minutes and 12.70 ± 1.70 minutes, respectively (p < 0.001). Out of the 9 patients who experienced treatment failure, 8 (88.90%) patients were in dexmedetomidine group and 1 (11.10%) was in midazolam group (p = 0.029). Absolute risk increase rate of treatment failure in case of using dexmedetomidine instead of midazolam was 17.50% (95%CI: 4.19 – 30.81) and number needed to harm was 6.00 (95% CI: 3.20 – 23.80). Conclusion: Although the combination of dexmedetomidine-fentanyl had a shorter time to recovery compared to midazolam-fentanyl for induction of sedation and analgesia, the treatment failure rate in case of using dexmedetomidine with 1 µg/kg increased 17.5% and about 1 out of each 6 patients needed a rescue dose.
- Conscious sedation
- analgesia
- dexmedetomidine
- midazolam
- closed fracture reduction
- clinical trial
References
Diaz-Garcia RJ, Oda T, Shauver MJ, Chung KC. A Systematic Review of Outcomes and Complications of Treating Unstable Distal Radius Fractures in the Elderly. The Journal of Hand Surgery. 2011;36(5):824-35.e2.
Hossein A, Majid S, Mehdi S, Somayeh A, Ali V, Alireza M. Nerve Stimulator Guided Axillary Block in Painless Reduction of Distal Radius Fractures; a Randomized Clinical Trial. Emergency (Tehran, Iran). 2013;1(1):11-4.
Myderrizi N, Mema B. The hematoma block an effective alternative for fracture reduction in distal radius fractures. Medical Archives. 2011;65(4):239.
Schofield S, Schutz J, Babl FE. Procedural sedation and analgesia for reduction of distal forearm fractures in the paediatric emergency department: a clinical survey. Emergency Medicine Australasia. 2013;25(3):241-7.
Godwin SA, Burton JH, Gerardo CJ, Hatten BW, Mace SE, Silvers SM, et al. Clinical policy: procedural sedation and analgesia in the emergency department. Annals of emergency medicine. 2014;63(2):247-58.e18.
Nejati A, Moharari RS, Ashraf H, Labaf A, Golshani K. Ketamine/propofol versus midazolam/fentanyl for procedural sedation and analgesia in the emergency department: a randomized, prospective, double‐blind trial. Academic Emergency Medicine. 2011;18(8):800-6.
dos Santos MEL, Maluf-Filho F, Chaves DM, Matuguma SE, Ide E, de Oliveira Luz G, et al. Deep sedation during gastrointestinal endoscopy: propofol-fentanyl and midazolam-fentanyl regimens. World Journal of Gastroenterology: WJG. 2013;19(22):3439.
Gertler R, Brown HC, Mitchell DH, Silvius EN. Dexmedetomidine: a novel sedative-analgesic agent. Proceedings (Baylor University Medical Center). 2001;14(1):13-21.
Shukry M, Miller JA. Update on dexmedetomidine: use in nonintubated patients requiring sedation for surgical procedures. Therapeutics and clinical risk management. 2010;6:111.
Frölich MA, Arabshahi A, Katholi C, Prasain J, Barnes S. Hemodynamic characteristics of midazolam, propofol, and dexmedetomidine in healthy volunteers. Journal of clinical anesthesia. 2011;23(3):218-23.
Vázquez-Reta J, Jiménez FM, Colunga-Sánchez A, Pizarro-Chávez S, Vázquez-Guerrero A, Vázquez-Guerrero A. Midazolam versus dexmedetomidine for sedation for upper gastrointestinal endoscopy. Revista de gastroenterologia de Mexico. 2011;76(1):13-8.
Zeyneloglu P, Pirat A, Candan S, Kuyumcu S, Tekin I, Arslan G. Dexmedetomidine causes prolonged recovery when compared with midazolam/fentanyl combination in outpatient shock wave lithotripsy. European journal of anaesthesiology. 2008;25(12):961-7.
Goneppanavar U, Magazine R, Periyadka Janardhana B, Krishna Achar S. Intravenous Dexmedetomidine Provides Superior Patient Comfort and Tolerance Compared to Intravenous Midazolam in Patients Undergoing Flexible Bronchoscopy. Pulmonary Medicine. 2015;2015:8.
Venn R, Grounds R. Comparison between dexmedetomidine and propofol for sedation in the intensive care unit: patient and clinician perceptions. British journal of anaesthesia. 2001;87(5):684-90.
Mahmoud M, Gunter J, Donnelly LF, Wang Y, Nick TG, Sadhasivam S. A comparison of dexmedetomidine with propofol for magnetic resonance imaging sleep studies in children. Anesthesia & Analgesia. 2009;109(3):745-53.
Senoglu N, Oksuz H, Dogan Z, Yildiz H, Demirkiran H, Ekerbicer H. Sedation during noninvasive mechanical ventilation with dexmedetomidine or midazolam: a randomized, double-blind, prospective study. Current Therapeutic Research. 2010;71(3):141-53.
Bergese SD, Khabiri B, Roberts WD, Howie MB, McSweeney TD, Gerhardt MA. Dexmedetomidine for conscious sedation in difficult awake fiberoptic intubation cases. Journal of clinical anesthesia. 2007;19(2):141-4.
- Abstract Viewed: 1148 times
- PDF Downloaded: 329 times