title: Comparison of two analgesia protocols for the treatment of pediatric orthopedic emergencies.
abstract: OBJECTIVE
  to compare the efficacy of two analgesia protocols (ketamine versus morphine) associated with midazolam for the reduction of dislocations or closed fractures in children.
  
  
  METHODS
  randomized clinical trial comparing morphine (0.1mg/kg; max 5mg) and ketamine (2.0mg/kg, max 70mg) associated with midazolam (0.2mg/kg; max 10mg) in the reduction of dislocations or closed fractures in children treated at the pediatrics emergency room (October 2010 and September 2011). The groups were compared in terms of the times to perform the procedures, analgesia, parent satisfaction and orthopedic team.
  
  
  RESULTS
  13 patients were allocated to ketamine and 12 to morphine, without differences in relation to age, weight, gender, type of injury, and pain scale before the intervention. There was no failure in any of the groups, no differences in time to start the intervention and overall procedure time. The average hospital stay time was similar (ketamine = 10.8+5.1h versus morphine = 12.3+4.4hs; p=0.447). The median pain (faces pain scale) scores after the procedure was 2 in both groups. Amnesia was noted in 92.3% (ketamine) and 83.3% (morphine) (p=0.904). Parents said they were very satisfied in relation to the analgesic intervention (84.6% in the ketamine group and 66.6% in the morphine group; p=0.296). The satisfaction of the orthopedist regarding the intervention was 92.3% in the ketamine group and 75% in the morphine group (p=0.222).
  
  
  CONCLUSIONS
  by producing results similar to morphine, ketamine can be considered as an excellent option in pain management and helps in the reduction of dislocations and closed fractures in pediatric emergency rooms.
authors.affiliation: Hospital Universitário, Pontifícia Universidade Católica do Rio Grande do Sul, RS, BR.
authors.forename: Andrea
authors.initials: A
authors.lastname: Barcelos
authors.affiliation: Medical School Pediatrics, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, BR.
authors.forename: Pedro Celiny Ramos
authors.initials: PC
authors.lastname: Garcia
authors.affiliation: Hospital Universitário, Pontifícia Universidade Católica do Rio Grande do Sul, RS, BR.
authors.forename: Janete L
authors.initials: JL
authors.lastname: Portela
authors.affiliation: Intensive Care and Emergency Service, Hospital de Clínicas, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, BR.
authors.forename: Jefferson P
authors.initials: JP
authors.lastname: Piva
authors.affiliation: Service and Head and Neck Surgery, Hospital São Lucas, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, BR.
authors.forename: João Pedro Tedesco
authors.initials: JP
authors.lastname: Garcia
authors.affiliation: Medical School, Pediatrics Department, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, BR.
authors.forename: João Carlos B
authors.initials: JC
authors.lastname: Santana
mesh_terms: D000759:Adjuvants, Anesthesia / Q000008:administration & dosage*; D000698:Analgesia / Q000592:standards*; D000700:Analgesics; D000701:Analgesics, Opioid / Q000008:administration & dosage; D002648:Child; D002675:Child, Preschool; D002985:Clinical Protocols / Q000592:standards; D004630:Emergencies; D004636:Emergency Service, Hospital / Q000592:standards; D005260:Female; D005596:Fractures, Closed / Q000628:therapy*; D006801:Humans; D004204:Joint Dislocations / Q000628:therapy*; D007649:Ketamine; D008297:Male; D008874:Midazolam; D009020:Morphine; D010147:Pain Measurement; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000759:Adjuvants, Anesthesia; D000700:Analgesics; D000701:Analgesics, Opioid; D007649:Ketamine; D009020:Morphine; D008874:Midazolam