title: Comparison of ketamine-low-dose midozolam with midazolam-fentanyl for orthopedic emergencies: a double-blind randomized trial.
abstract: OBJECTIVE
  Most of the fractures and dislocations are reduced in the emergency setting. Many drugs are available for procedural sedation and analgesia in the emergency department (ED); however, the adverse effects are still a common problem. The aim of our study was to compare the 2 drug combinations.
  
  
  METHODS
  We performed a prospective, randomized, double-blinded, placebo-controlled trial of patients presenting to the ED after a traumatic event and required urgent reduction either for a fracture or dislocation. Patients were randomized to midazolam-fentanyl (MF) group or ketamine-low-dose midazolam (KM) group. Hypoxia, duration of hypoxia, need for oxygen, time to onset of sedation, recovery time, pain scores during reduction, and sedation depth were set as primary outcome measures and were recorded.
  
  
  RESULTS
  A total of 498 patients who presented to ED with extremity injury and required closed reduction were assessed; 130 of them were approached for eligibility and 69 patients were excluded. The remaining 61 patients were randomized to either KM group (n = 31) or MF group (n = 30). Hypoxia and duration of hypoxia were significantly lower in the KM group compared with the MF group. Patients in the KM group reported significantly lower pain scores during reduction; however, adverse effects were higher compared with MF group.
  
  
  CONCLUSIONS
  Both drug combinations can be effectively used for procedural sedation and analgesia; however, with lower risk for hypoxia and lower pain scores, KM combination stands as a reasonable choice for orthopedic interventions in the emergency unit.
authors.affiliation: Department of Emergency Medicine, Gulhane Military Medical Academy, GATA Acil Tip Anabilim Dalı, Etlik, Ankara 06010, Turkey. cevikerdem@yahoo.com
authors.forename: Erdem
authors.initials: E
authors.lastname: Cevik
authors.forename: Serkan
authors.initials: S
authors.lastname: Bilgic
authors.forename: Erden
authors.initials: E
authors.lastname: Kilic
authors.forename: Orhan
authors.initials: O
authors.lastname: Cinar
authors.forename: Hakan
authors.initials: H
authors.lastname: Hasman
authors.forename: Ayhan Yahya
authors.initials: AY
authors.lastname: Acar
authors.forename: Murat
authors.initials: M
authors.lastname: Eroglu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000700:Analgesics / Q000008:administration & dosage*; D018686:Anesthetics, Intravenous / Q000008:administration & dosage*; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D004311:Double-Blind Method; D004338:Drug Combinations; D004636:Emergency Service, Hospital; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage*; D050723:Fractures, Bone / Q000628:therapy*; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage*; D004204:Joint Dislocations / Q000628:therapy*; D007649:Ketamine / Q000008:administration & dosage*; D008297:Male; D008874:Midazolam / Q000008:administration & dosage*; D008875:Middle Aged; D010147:Pain Measurement; D010919:Placebos; D011446:Prospective Studies; D018709:Statistics, Nonparametric; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000700:Analgesics; D018686:Anesthetics, Intravenous; D004338:Drug Combinations; D006993:Hypnotics and Sedatives; D010919:Placebos; D007649:Ketamine; D008874:Midazolam; D005283:Fentanyl