Dexmedetomidine versus Midazolam-Fentanyl in Procedural Analgesia Sedation for Reduction of Anterior Shoulder Dislocation: A Randomized Clinical Trial

Abstract

Background: Shoulder joint dislocation is the most common dislocation of joints in the body. To reduce the anterior shoulder dislocation, it is necessary to have analgesia and sedation. Methods: In this randomized clinical trial, patients were divided into two equal groups. Group I received midazolam-fentanyl (0.05 mg/kg fentanyl at a dose of 1 µg/kg) for 10 minutes and group II received dexmedetomidine (1 µg/kg in the initial dose and then 0.2 µg/kg/h) for 10 minutes. The levels of analgesia according to VAS criteria and the time to reach desired sedation were compared between the two groups. Results: A total of 60 patients participated in this study. The time to reach the desired sedation was 8.60 ± 2.3 minutes in the dexmedetomidine group and 11.27 ± 3.57 minutes in the midazolamfentanyl group (p= 0.001). Also, the VAS score in both midazolam-fentanyl and dexmedetomidine groups was 3.3 ± 1.24 and 2.57 ± 0.9, respectively. The differences were statistically significant (p=0.015). There was significant relationship between the time to reach desired sedation and the level of analgesia. Moreover, there was no significant difference between patient age and the time to reach the desired level of analgesia. During this study, no side effect was observed. Conclusion: The findings of this study show that dexmedetomidine provides a higher level of analgesia than midazolam-fentanyl. Moreover, it was also shown that dexmedetomidine causes quicker procedural sedation than midazolam-fentanyl.

The use of dexmedetomidine in the emergency department: A systematic review

“…Study designs included 11 RCTs, 22,32–41 13 cohort studies and other nonrandomized studies, 19–21,23,42–50 and 11 case series and case reports 12,51–60 . Six of the included studies were conference abstracts 20,21,40,47,50,56 .…”

“…Interestingly, Chumpitazi et al 47 did find that intranasal administration of DEX for procedural in pediatric patients was not associated with increased ED length of stay compared to IV ketamine (likely due to delays involved in establishing IV access in children). However, it is not clear from the included studies that the onset of appropriate sedation after administration of IV DEX, which could take up to 8–10 min in adults, 32,39 would be consistent with usual ED procedural sedation practices.…”

“…Study designs included 11 RCTs, 22,[32][33][34][35][36][37][38][39][40][41] 13 cohort studies and other nonrandomized studies, [19][20][21]23,[42][43][44][45][46][47][48][49][50] and 11 case series and case reports. 12,[51][52][53][54][55][56][57][58][59][60] Six of the included studies were conference abstracts.…”

“…The most common indication for DEX was procedural sedation, which was reported in three RCTs, 32,36,39 six cohort and nonrandomized studies, 19,20,43,47,48,50 and two case reports or series. 52,53 Pooling of efficacy results was not feasible due to the heterogeneity of DEX dose and route, procedures being reported, and outcome measurements used.…”

The Use of Dexmedetomidine in the Emergency Department: A Cohort Study

“…Although the data are limited, a few studies have shown that DEX may reduce the need for endotracheal intubation in patients with alcohol withdrawal, and be a safe and effective procedural sedation agent. [6][7][8][9] Given the lack of data and trials regarding DEX use in the ED, there is a significant knowledge gap and lack of familiarity regarding the use of this agent. Furthermore, as DEX has consistently been shown to increase the incidence of hypotension and bradycardia, its safety profile in the ED during routine use is unknown as well.…”