Effectiveness and safety of dentist-led conscious sedation using fentanyl with midazolam in dentistry: a five-year retrospective service evaluation

Abstract

Background Fentanyl provides systemic analgesia and enhances the sedative effect of benzodiazepines. When midazolam-only sedation is ineffective, fentanyl can be considered as an adjunct, but this advanced sedation technique requires additional training. Studies reporting on the safety and effectiveness of dentist-led conscious sedation using fentanyl and midazolam are lacking. Aims To review the indication of use, safety and effectiveness of fentanyl and midazolam sedation at The Royal London Dental Hospital since its introduction into the service. Method Retrospective data collection of sedation cases from October 2016 to October 2021 was carried out. Results Of the 109 cases included, the majority of patients who had fentanyl (90.8%) had a history of unsuccessful sedation with midazolam. A lower average dose of midazolam was administered when fentanyl was used; the difference was statistically significant (p <0.0001). A higher proportion of patients who had fentanyl and midazolam presented with lower Ellis scores (better operating condition) compared to midazolam-only sedation. No adverse incidents were recorded. Conclusion In this evaluation, the synergistic effects of fentanyl and midazolam resulted in enhanced sedation, anxiolysis and intraoperative conditions. This service evaluation showed some encouraging data regarding the potential safety profile and effectiveness of fentanyl in dental sedation when used by experienced clinicians; however, larger scale studies are required to validate this.

Perioperative analgesic efficacy and adverse events of fentanyl in dentistry: A systematic review

“…Fentanyl is typically used to control perioperative pain; however, because of its high hepatic clearance, it is frequently used as a sedative (Sadhvi et al, 2022;Yeo & Shehabi, 2023). It is available in a variety of forms, including intramuscular, intrathecally, or intravenously injected solution, intranasal or sublingual spray, buccal or sublingual tablets, transmucosal lozenges, and self-adhesive transdermal skin patches (Yeo & Shehabi, 2023). Moreover, fentanyl can be used alone or in combination with other medicines for general or regional anesthetic induction, maintenance, and recovery (Agarwal et al, 2023;Choi et al, 2019;Thakur et al, 2023;Yeo & Shehabi, 2023).…”

“…It is analgesic and sedative with a quick onset of action (Sadhvi et al., 2022). It is a prescription‐only medication that is classified as a Schedule 2 controlled drug under the misuse of drugs (Preuss et al., 2023; Yeo & Shehabi, 2023).…”

“…Fentanyl is typically used to control perioperative pain; however, because of its high hepatic clearance, it is frequently used as a sedative (Sadhvi et al., 2022; Yeo & Shehabi, 2023). It is available in a variety of forms, including intramuscular, intrathecally, or intravenously injected solution, intranasal or sublingual spray, buccal or sublingual tablets, transmucosal lozenges, and self‐adhesive transdermal skin patches (Yeo & Shehabi, 2023).…”