Propofol Versus Midazolam for Procedural Sedation of Anterior Shoulder Dislocation in Emergency Department: A Randomized Clinical Trial.
BACKGROUND
Anterior shoulder dislocation (ASD) is one of the most common reasons for referrals to emergency departments (ED). Usually, a combination of an intravenous narcotic and a benzodiazepine is used for procedural sedation and analgesia (PSA) in such cases.


OBJECTIVE
This study compares the efficacy of two combinations to reduce ASD.


METHODS
The subjects in this clinical trial consisted of 48 patients with ASD who were randomly assigned to midazolam/fentanyl and propofol/fentanyl groups for PSA. The two groups were compared to the time interval between injection and induction of sedation (T1), duration of time from sedation to awakening (T2), the duration of time between sedation and full awareness to time, location and individuals (T3), and possible side effects.


RESULTS
Twenty-nine subjects (60.4%) were sedated with midazolam and 19 (39.6%) were sedated with propofol. During the procedure, one patient in the propofol group experienced apnea (P = 0.39) and three patients (one in the midazolam group and two in the propofol group) experienced bradycardia (P = 0.34). The mean T1, T2, and T3 were significantly shorter in the propofol group (P < 0.001).


CONCLUSIONS
It seems that propofol and fentanyl can be used as a safe and fast combination for PSA in the reduction of ASD.
Safety Promotion and Injury Prevention Research Center, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran.
Hamid Reza
HR
Hatamabadi
Department of Emergency Medicine, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran.
Ali
A
Arhami Dolatabadi
Department of Emergency Medicine, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran.
Hojjat
H
Derakhshanfar
Department of Emergency Medicine, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran.
Somaye
S
Younesian
Department of Emergency Medicine, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran.
Ensieh
E
Ghaffari Shad
Analgesic; Midazolam; Propofol; Sedation; Shoulder Dislocation