A Randomised Controlled Trial Comparing Ketamine versus Fentanyl for Procedural Sedation in the Emergency Department for Adults with Isolated Extremity Injury
https://doi.org/10.5704/MOJ.2403.015
- Author:
Srinivasarangan M
1
;
Jagadeesh S
1
;
Bheemanna A
1
;
Sivasankar A
1
;
Patil A
2
;
Basavaraju B
1
;
Sattur A
1
Author Information
1. Department of Emergency Medicine, JSS Medical College, Mysuru, India
2. Department of Anesthesiology, Dr Moopens Medical College, Wayanad, India
- Publication Type:Journal Article
- Keywords:
procedural sedation and analgesia, emergency department, ketamine, fentanyl, extremity trauma
- From:Malaysian Orthopaedic Journal
2024;18(No.1):116-124
- CountryMalaysia
- Language:English
-
Abstract:
Introduction: Alleviating pain and anxiety of patients
during procedures is an essential skill for an Emergency
Physician (EP). Several sedatives and dissociative agents are
used for PSA (Procedural Sedation and Analgesia). In this
study, we aimed to compare two drugs that is, ketamine and
fentanyl for procedural sedation in adults with isolated limb
injuries in the Emergency Department (ED).
Materials and methods: In this prospective, randomised
controlled interventional trial, patients aged between 18 to
65 years with isolated extremity injury requiring PSA in the
ED were recruited. A total of 200 subjects were included in
the study and randomly allocated to either the fentanyl
(n=100) or the ketamine (n=100) group. Patients were
blinded to the intervention and subsequently premedicated
with Midazolam. Following this, they received either
ketamine or fentanyl based on the group they were allocated
to. Vital signs, including but not limited to the level of
sedation, were measured at predetermined time intervals. A
Modified Aldrete Score of >8 was used as a criterion for
disposition from the ED. Data were collected in a predesigned proforma. We aimed to compare the effectiveness
as well as ascertain the safety profile of the two drugs for
PSA in the ED.
Results: There was no significant difference between the
two groups when age, gender, mechanism of injury and
comorbidities were compared. We found that there was no
statistically significant difference between the two groups
when blood pressure, respiratory rate and depth of sedation
were compared. In both groups, there was a significant
decrease in pain on the Numerical Rating Scale (NRS)
following drug administration from 8 to 3 (p<0.001).
Patients in the fentanyl group had an increased incidence of
transient oxygen desaturation (p<0.001). Vomiting was more
common in the ketamine group (p<0.001).
Conclusion: PSA is a safe and efficacious procedure for
patients undergoing painful procedures in ED. Patients in
both the groups maintained hemodynamic stability
throughout the procedure. From our study, we were able to
conclude that both ketamine and fentanyl are similar in
efficacy for PSA in the ED for adults with isolated limb
injuries. In addition, no significant cardiovascular adverse
events were noted in either group in our study.
- Full text:202408121501038892716.2024my1359.pdf
