Abstract
Objective
Many procedures performed in emergency department are stressful and painful, and creating
proper and timely analgesia and early and effective assessment are the challenges
in this department. This study has been conducted in order to compare the efficacy
of propofol and fentanyl combination with propofol and ketamine combination for procedural
sedation and analgesia (PSA) in trauma patients in the emergency department.
Method
This is a randomized prospective double-blind clinical trial conducted in the emergency
department of Imam Khomeini Hospital, a tertiary academic trauma center in northern
Iran. Patients with trauma presenting to the emergency department who needed PSA were
included in study. Patients were divided into two groups of propofol fentanyl (PF)
and propofol ketamine (PK). Pain score and sedation depth were set as primary outcome
measures and were recorded.
Results
Out of about 379 patients with trauma, who needed PSA, 253 met the criteria to be
included in the study, 117 of which were excluded. The remaining 136 patients were
randomly allocated to either PF group (n = 70) or PK group (n = 66). Pain management
after drug administration was significantly different between the groups and the analgesia
caused by fentanyl was significantly higher than ketamine. The sedation score after
15 min of PSA in the group PF was significantly higher than the group PK.
Conclusion
It seems that regarding PSA in the emergency department, PF caused better analgesia
and deeper sedation and it is recommended to use PF for PSA in the emergency departments.
Keywords
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References
- Pain in the emergency department: results of the Pain and Emergency Medicine Initiative (PEMI) Multicenter Study.J Pain. 2007; 8: 460-466
- Garrison, sedation and analgesia for pediatric fracture reduction in the emergency department. A systematic review.Arch Pediatr Adolesc Med. 2006 Jan; 160: 46-51
- A double-blind, randomised, placebo-controlled trial of oral midazolam plus oral ketamine for sedation of children during laceration repaire.Emerg Med J. 2014; 31: 649-653
- Clinical policy: procedural sedation and analgesia in the emergency department.Ann Emerg Med. 2005; 45: 177-196
- Patient satisfaction and return to daily activities using etomidate procedural sedation for orthopedic injuries.West J Emerg Med. 2008; 9: 86-90
- Procedural sedation and analgesia in a Canadian ED: a time-in-motion study.Am J Emerg Med. 2011; 29: 1083-1088
- Evidence and consensus based guideline for the management of delirium, analgesia, and sedation in intensive care medicine. Revision 2015 (DAS-Guideline 2015) — short version.Ger Med Sci. 2015; 13Doc19
- Procedural sedation and analgesia in rural and regional emergency departments.Can J Rural Med. 2013 Fall; 18: 130-136
- Propofol versus combined sedation in flexible bronchoscopy: a randomised non-inferiority trial.Eur Respir J. 2009; 34: 1024-1030
- Sedation during bronchoscopy: data from a nationwide sedation and monitoring survey.BMC Pulm Med. 2016 Aug 5; 16: 113
- Ketamine-propofol versus propofol alone for procedural sedation in the emergency department: a systematic review and meta-analysis.Acad Emerg Med. 2015 Sep; 22: 1003-1013
Wakai A,Blackburn C, Mccabe A, Reece E, O'Connor G, et al. The use of propofol for procedural sedation in emergency departments. Cochrane Database Syst Rev 2015, Issue 7. Art. No.: CD007399.
- Intravenous infusion of ketamine-propofol can be an alternative to intravenous infusion of fentanyl-propofol for deep sedation and analgesia in paediatric patients undergoing emergency short surgical procedures.Indian J Anaesth. 2012 Mar; 56: 145-150
- Propofol/alfentanil and propofol/ketamine procedural sedation in children with acute lymphoblastic leukaemia: safety, efficacy and their correlation with pain neuromediator expression.Eur J Cancer Care (Engl). 2010 Mar; 19 (May 21): 212-220
- Sedative and analgesic effects of propofol-fentanyl versus propofol-ketamine during endoscopic retrograde cholangiopancreatography: a double-blind randomized clinical trial.Anesth Pain Med. 2016 Aug 22; 6 (eCollection 2016 Oct)e39835
- Propofol-ketamine vs propofol-fentanyl for sedation during pediatric upper gastrointestinal endoscopy.Paediatr Anaesth. 2007; 17: 983-988
- Comparison of propofol and ketamine versus propofol and fentanyl for puerperal sterilization, a randomized clinical trial.J Clin Diagn Res. 2014 May; 8: GC01-4
- Comparison of propofol, propofol-remifentanil, and propofol-fentanyl administrations with each other used for the sedation of patients to undergo ERCP.Biomed Res Int. 2015; 2015465465
- A comparison of fentanyl-propofol with a ketamine-propofol combination for sedation during endometrial biopsy.J Clin Anesth. 2005; 17: 187-190
- A randomized controlled trial to compare fentanyl-propofol and ketamine-propofol combination for procedural sedation and analgesia in laparoscopic tubal ligation.Saudi J Anaesth. 2013 Jan; 7: 24-28
- Comparison of ketamine-low-dose midozolam with midazolam-fentanyl for orthopedic emergencies: a double-blind randomized trial.Am J Emerg Med. 2013 Jan; 31: 108-113
Article Info
Publication History
Published online: February 02, 2018
Accepted:
January 25,
2018
Received in revised form:
January 24,
2018
Received:
September 30,
2017
Identification
Copyright
© 2018 Elsevier Inc. All rights reserved.
