THE IMPORTANCE OF ANALGO-SEDATION IN THE PATIENT WITH SERIOUS PELVIC AND SPINE TRAUMA DURING TRANSPORT

Abstract

This prospective, randomised study aimed to assess the efficacy of ketamine/propofol (K/P) compared to the commonly used fentanyl/midazolam (F/M) combination in providing analgesia for patients with severe pelvic and spinal trauma. The study, conducted over 30 months on 154 patients, found that the K/P group experienced significantly lower perceived pain levels, as measured on the numerical pain scale, when compared to the F/M group (p < 0.0001). Additionally, patients in the K/P group achieved adequate sedation with an average Ramsay scale score of 3.1, while the F/M group had a more profound sedation with a score of 5.5 (p < 0.0001). Furthermore, the study demonstrated that analgesia with K/P significantly improved the physiological severity score (PSS) (p < 0.0001) and resulted in a notably lower incidence of oxygen desaturation, with only one patient experiencing this in the K/P group compared to 16 patients in the F/M group (p = 0.0003). These findings suggest that co-administration of low-dose ketamine and propofol provides safe and effective sedation and analgesia, both in the emergency department and pre-hospital settings. The study highlights the importance of adequate pain management in severe trauma cases and emphasizes the potential advantages of using the K/P combination over F/M, particularly due to the reduced risk of oxygen desaturation and the more moderate level of sedation achieved with K/P. These results underscore the potential clinical utility of this approach in improving the overall care and outcomes of patients with severe pelvic and spinal trauma