Comparison of meperidine plus midazolam and fentanyl plus midazolam in procedural sedation: A double-blind, randomized controlled trial

Abstract

This double-blind, randomized, prospective study was conducted to compare the analgesic and sedative efficacy of fentanyl and meperidine in orthopedic closed reduction of fractures and dislocations undertaken in the emergency department. Seventy consecutive adult patients with fractures or dislocations suitable for reduction were randomized to receive fentanyl (1 mcg/kg; n = 36) or meperidine (0.5 mg/kg; n = 34) in combination with midazolam (0.02 mg/kg). Vital signs and alertness scale scores of the patients were monitored. The Visual Analog Scale (VAS) was used to determine the degree of pain. There was no statistically significant difference between the VAS mean scores of the fentanyl and meperidine groups (t test, P = .772). The need for additional analgesic drugs was significantly more frequent in patients receiving meperidine (P = .018). No adverse events, such as hypotension or respiratory depression, were noted. Euphoria occurred in one patient in the fentanyl group. Although dose requirements differ, fentanyl and meperidine provide effective and reliable analgesia in closed reduction of fractures and dislocations.

Safety and Clinical Effectiveness of Midazolam versus Propofol for Procedural Sedation in the Emergency Department: A Systematic Review

“…6,[10][11][12] We found 9 additional RCTs that did not report direct comparisons between the study drugs, but in which either midazolam or propofol had been studied and could be included in the analysis of AEs. 2,5,21,22,[29][30][31][32][33][34] An additional 15 observational studies met inclusion criteria for the analysis of AEs. 1,15,20,23,24,33,[35][36][37][38][39][40][41][42][43] Study Characteristics Studies included in the analysis of AEs enrolled between 4 and 860 patients (see supplementary Table S1).…”

Efficacy of opioids for traumatic pain in the emergency department: a systematic review and Bayesian network meta-analysis

“…A total of 19,720 were retrieved from PubMed (n = 3,577), Embase (n = 5,113), Cochrane Library (n = 8,024), and Web of Science (n = 3,006). After deleting duplicates (n = 7,891), and excluding ineligible studies based on titles and abstracts (n = 11,698) and on full texts (n = 111), 20 studies ( Turturro et al, 1998 ; Vergnion et al, 2001 ; Miller and Ernst, 2004 ; Soysal et al, 2004 ; Marco et al, 2005 ; Hewitt et al, 2007 ; Bounes et al, 2010 ; Shear et al, 2010 ; Jalili et al, 2012 ; Smith et al, 2012 ; Wenderoth et al, 2013 ; Shervin et al, 2014 ; Zare et al, 2014 ; Chang et al, 2017 ; Chew and Shaharudin, 2017 ; Eizadi et al, 2018 ; Pan et al, 2018 ; Blancher et al, 2019 ; Vahedi et al, 2019 ; Bijur et al, 2021 ) of 3,040 patients were eventually included in this network meta-analysis. Figure 1 shows the flow chart of study screening.…”

Procedural Sedation by Registered Nurses in the Interventional Radiology Setting: Incorporating Evidence-Based Practice Regarding Medication Selection, Fasting, and Mitigating Cardiorespiratory Complications

“…Soysal et al (2004) performed a double-blind, randomized, and prospective study on a small (n = 70) group of emergency department patients who required closed reduction for fractures and dislocations. The study compared the use of meperidine and midazolam to the use of fentanyl and midazolam.…”