Dexmedetomidine-Fentanyl versus Midazolam-Fentanyl in Pain Management of Distal Radius Fractures Reduction; a Randomized Clinical Trial
Introduction:Â 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...
| Main Authors: | , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Shahid Beheshti University of Medical Sciences
2018-11-01
|
| Series: | Archives of Academic Emergency Medicine |
| Subjects: | |
| Online Access: | https://journals.sbmu.ac.ir/aaem/index.php/AAEM/article/view/53 |
| _version_ | 1818042798137409536 |
|---|---|
| author | Ali Arhami-Dolatabadi Elham Memary Majid Shojaee Hossein Kamalifard |
| author_facet | Ali Arhami-Dolatabadi Elham Memary Majid Shojaee Hossein Kamalifard |
| author_sort | Ali Arhami-Dolatabadi |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-12-10T08:52:02Z |
| format | Article |
| id | doaj.art-a58d5911dcbe4f59a56b0b8d874927bc |
| institution | Directory Open Access Journal |
| issn | 2645-4904 |
| language | English |
| last_indexed | 2024-12-10T08:52:02Z |
| publishDate | 2018-11-01 |
| publisher | Shahid Beheshti University of Medical Sciences |
| record_format | Article |
| series | Archives of Academic Emergency Medicine |
| spelling | doaj.art-a58d5911dcbe4f59a56b0b8d874927bc2022-12-22T01:55:33ZengShahid Beheshti University of Medical SciencesArchives of Academic Emergency Medicine2645-49042018-11-016110.22037/aaem.v6i1.53Dexmedetomidine-Fentanyl versus Midazolam-Fentanyl in Pain Management of Distal Radius Fractures Reduction; a Randomized Clinical TrialAli Arhami-Dolatabadi0Elham Memary1Majid Shojaee2Hossein Kamalifard3Emergency Department, Imam Hossein Hospital, Shahid Beheshti University Of Medical Sciences, Tehran, Iran.Anesthesiology Department, Imam Hossein Hospital, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.Emergency Department, Imam Hossein Hospital, Shahid Beheshti University Of Medical Sciences, Tehran, Iran.Emergency Department, Imam Hossein Hospital, Shahid Beheshti University Of Medical Sciences, Tehran, Iran.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.https://journals.sbmu.ac.ir/aaem/index.php/AAEM/article/view/53Conscious sedationanalgesiadexmedetomidinemidazolamclosed fracture reductionclinical trial |
| spellingShingle | Ali Arhami-Dolatabadi Elham Memary Majid Shojaee Hossein Kamalifard Dexmedetomidine-Fentanyl versus Midazolam-Fentanyl in Pain Management of Distal Radius Fractures Reduction; a Randomized Clinical Trial Archives of Academic Emergency Medicine Conscious sedation analgesia dexmedetomidine midazolam closed fracture reduction clinical trial |
| title | Dexmedetomidine-Fentanyl versus Midazolam-Fentanyl in Pain Management of Distal Radius Fractures Reduction; a Randomized Clinical Trial |
| title_full | Dexmedetomidine-Fentanyl versus Midazolam-Fentanyl in Pain Management of Distal Radius Fractures Reduction; a Randomized Clinical Trial |
| title_fullStr | Dexmedetomidine-Fentanyl versus Midazolam-Fentanyl in Pain Management of Distal Radius Fractures Reduction; a Randomized Clinical Trial |
| title_full_unstemmed | Dexmedetomidine-Fentanyl versus Midazolam-Fentanyl in Pain Management of Distal Radius Fractures Reduction; a Randomized Clinical Trial |
| title_short | Dexmedetomidine-Fentanyl versus Midazolam-Fentanyl in Pain Management of Distal Radius Fractures Reduction; a Randomized Clinical Trial |
| title_sort | dexmedetomidine fentanyl versus midazolam fentanyl in pain management of distal radius fractures reduction a randomized clinical trial |
| topic | Conscious sedation analgesia dexmedetomidine midazolam closed fracture reduction clinical trial |
| url | https://journals.sbmu.ac.ir/aaem/index.php/AAEM/article/view/53 |
| work_keys_str_mv | AT aliarhamidolatabadi dexmedetomidinefentanylversusmidazolamfentanylinpainmanagementofdistalradiusfracturesreductionarandomizedclinicaltrial AT elhammemary dexmedetomidinefentanylversusmidazolamfentanylinpainmanagementofdistalradiusfracturesreductionarandomizedclinicaltrial AT majidshojaee dexmedetomidinefentanylversusmidazolamfentanylinpainmanagementofdistalradiusfracturesreductionarandomizedclinicaltrial AT hosseinkamalifard dexmedetomidinefentanylversusmidazolamfentanylinpainmanagementofdistalradiusfracturesreductionarandomizedclinicaltrial |