右美托咪定-芬太尼与咪唑安定-芬太尼治疗桡骨远端骨折的疗效比较；随机临床试验

Emergency Pub Date : 2018-01-20 DOI:10.22037/EMERGENCY.V6I1.19907

Ali Arhami Dolatabadi, Elham Memary, Majid Shojaee, Hossein Kamalifard

{"title":"右美托咪定-芬太尼与咪唑安定-芬太尼治疗桡骨远端骨折的疗效比较；随机临床试验","authors":"Ali Arhami Dolatabadi, Elham Memary, Majid Shojaee, Hossein Kamalifard","doi":"10.22037/EMERGENCY.V6I1.19907","DOIUrl":null,"url":null,"abstract":"Introduction: Currently, using various combinations of narcotic and analgesic drugs has received attention for induction of sedation and analgesia due to their synergy in controlling pain and anxiety. The present study was designed with the aim of comparing dexmedetomidine-fentanyl combination with midazolam-fentanyl in this regard. Methods: In this randomized clinical trial, patients diagnosed with distal radius fracture who had visited the emergency department (ED) were allocated to either the group receiving the combination of fentanyl-midazolam or the one receiving dexmedetomidine-fentanyl for procedural sedation and analgesia (PSA) and were compared regarding analgesic characteristics, time to recovery and side effects. Results: 80 patients with the mean age of 42.08 ± 12.17 (18 - 60) years were randomly allocated to 2 groups of 40 (83.80% male). The 2 groups did not have a significant difference regarding baseline characteristics as well as pain severity. Mean pain score at the time of procedure was 3.47 ± 1.37 in dexmedetomidine and 2.85 ± 1.05 in midazolam group (p = 0.025). In addition, time to recovery in dexmedetomidine and midazolam groups was 6.60 ± 1.86 minutes and 12.70 ± 1.70 minutes, respectively (p < 0.001). Out of the 9 patients who experienced treatment failure, 8 (88.90%) patients were in dexmedetomidine group and 1 (11.10%) was in midazolam group (p = 0.029). Absolute risk increase rate of treatment failure in case of using dexmedetomidine instead of midazolam was 17.50% (95%CI: 4.19 – 30.81) and number needed to harm was 6.00 (95% CI: 3.20 – 23.80). Conclusion: Although the combination of dexmedetomidine-fentanyl had a shorter time to recovery compared to midazolam-fentanyl for induction of sedation and analgesia, the treatment failure rate in case of using dexmedetomidine with 1 µg/kg increased 17.5% and about 1 out of each 6 patients needed a rescue dose.","PeriodicalId":11681,"journal":{"name":"Emergency","volume":" ","pages":""},"PeriodicalIF":0.0000,"publicationDate":"2018-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"1","resultStr":"{\"title\":\"Dexmedetomidine-Fentanyl versus Midazolam-Fentanyl in Pain Management of Distal Radius Fractures Reduction; a Randomized Clinical Trial\",\"authors\":\"Ali Arhami Dolatabadi, Elham Memary, Majid Shojaee, Hossein Kamalifard\",\"doi\":\"10.22037/EMERGENCY.V6I1.19907\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"Introduction: Currently, using various combinations of narcotic and analgesic drugs has received attention for induction of sedation and analgesia due to their synergy in controlling pain and anxiety. The present study was designed with the aim of comparing dexmedetomidine-fentanyl combination with midazolam-fentanyl in this regard. Methods: In this randomized clinical trial, patients diagnosed with distal radius fracture who had visited the emergency department (ED) were allocated to either the group receiving the combination of fentanyl-midazolam or the one receiving dexmedetomidine-fentanyl for procedural sedation and analgesia (PSA) and were compared regarding analgesic characteristics, time to recovery and side effects. Results: 80 patients with the mean age of 42.08 ± 12.17 (18 - 60) years were randomly allocated to 2 groups of 40 (83.80% male). The 2 groups did not have a significant difference regarding baseline characteristics as well as pain severity. Mean pain score at the time of procedure was 3.47 ± 1.37 in dexmedetomidine and 2.85 ± 1.05 in midazolam group (p = 0.025). In addition, time to recovery in dexmedetomidine and midazolam groups was 6.60 ± 1.86 minutes and 12.70 ± 1.70 minutes, respectively (p < 0.001). Out of the 9 patients who experienced treatment failure, 8 (88.90%) patients were in dexmedetomidine group and 1 (11.10%) was in midazolam group (p = 0.029). Absolute risk increase rate of treatment failure in case of using dexmedetomidine instead of midazolam was 17.50% (95%CI: 4.19 – 30.81) and number needed to harm was 6.00 (95% CI: 3.20 – 23.80). Conclusion: Although the combination of dexmedetomidine-fentanyl had a shorter time to recovery compared to midazolam-fentanyl for induction of sedation and analgesia, the treatment failure rate in case of using dexmedetomidine with 1 µg/kg increased 17.5% and about 1 out of each 6 patients needed a rescue dose.\",\"PeriodicalId\":11681,\"journal\":{\"name\":\"Emergency\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2018-01-20\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"1\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Emergency\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.22037/EMERGENCY.V6I1.19907\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Emergency","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.22037/EMERGENCY.V6I1.19907","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}

引用次数: 1

摘要

导读:目前，麻醉性镇痛药物的各种联合应用因其在控制疼痛和焦虑方面的协同作用而引起镇静镇痛的关注。本研究旨在比较右美托咪定-芬太尼联用与咪达唑仑-芬太尼联用在这方面的疗效。方法:在本随机临床试验中，将就诊于急诊科(ED)的桡骨远端骨折患者分为芬太尼-咪达唑仑联合组和右美托咪定-芬太尼联合组进行程序镇静镇痛(PSA)，比较镇痛特性、恢复时间和不良反应。结果:80例患者平均年龄42.08±12.17(18 ~ 60)岁，随机分为两组，每组40例，其中男性占83.80%。两组在基线特征和疼痛严重程度方面没有显著差异。右美托咪定组手术时平均疼痛评分为3.47±1.37，咪达唑仑组为2.85±1.05 (p = 0.025)。右美托咪定组和咪达唑仑组恢复时间分别为6.60±1.86 min和12.70±1.70 min (p < 0.001)。治疗失败的9例患者中，右美托咪定组8例(88.90%)，咪达唑仑组1例(11.10%)(p = 0.029)。用右美托咪定替代咪达唑仑治疗失败的绝对风险增加率为17.50% (95%CI: 4.19 ~ 30.81)，需要伤害的人数为6.00 (95%CI: 3.20 ~ 23.80)。结论:虽然右美托咪定-芬太尼联用诱导镇静镇痛的恢复时间较咪达唑仑-芬太尼短，但使用1 μ g/kg右美托咪定治疗失败率增加17.5%，每6例患者中约有1例需要抢救剂量。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

查看原文本刊更多论文

Dexmedetomidine-Fentanyl versus Midazolam-Fentanyl in Pain Management of Distal Radius Fractures Reduction; a Randomized Clinical Trial

Introduction: Currently, using various combinations of narcotic and analgesic drugs has received attention for induction of sedation and analgesia due to their synergy in controlling pain and anxiety. The present study was designed with the aim of comparing dexmedetomidine-fentanyl combination with midazolam-fentanyl in this regard. Methods: In this randomized clinical trial, patients diagnosed with distal radius fracture who had visited the emergency department (ED) were allocated to either the group receiving the combination of fentanyl-midazolam or the one receiving dexmedetomidine-fentanyl for procedural sedation and analgesia (PSA) and were compared regarding analgesic characteristics, time to recovery and side effects. Results: 80 patients with the mean age of 42.08 ± 12.17 (18 - 60) years were randomly allocated to 2 groups of 40 (83.80% male). The 2 groups did not have a significant difference regarding baseline characteristics as well as pain severity. Mean pain score at the time of procedure was 3.47 ± 1.37 in dexmedetomidine and 2.85 ± 1.05 in midazolam group (p = 0.025). In addition, time to recovery in dexmedetomidine and midazolam groups was 6.60 ± 1.86 minutes and 12.70 ± 1.70 minutes, respectively (p < 0.001). Out of the 9 patients who experienced treatment failure, 8 (88.90%) patients were in dexmedetomidine group and 1 (11.10%) was in midazolam group (p = 0.029). Absolute risk increase rate of treatment failure in case of using dexmedetomidine instead of midazolam was 17.50% (95%CI: 4.19 – 30.81) and number needed to harm was 6.00 (95% CI: 3.20 – 23.80). Conclusion: Although the combination of dexmedetomidine-fentanyl had a shorter time to recovery compared to midazolam-fentanyl for induction of sedation and analgesia, the treatment failure rate in case of using dexmedetomidine with 1 µg/kg increased 17.5% and about 1 out of each 6 patients needed a rescue dose.

求助全文

通过发布文献求助，成功后即可免费获取论文全文。去求助

来源期刊

Emergency EMERGENCY MEDICINE-

自引率

0.00%

发文量

审稿时长

8 weeks

期刊介绍： "Archives of Academic Emergency Medicine" is an international, Open Access, peer-reviewed, continuously published journal dedicated to improving the quality of care and increasing the knowledge in the field of emergency medicine by publishing high quality articles concerning emergency medicine and related disciplines. All accepted articles will be published immediately in order to increase its visibility and possibility of citation. The journal publishes articles on critical care, disaster and trauma management, environmental diseases, toxicology, pediatric emergency medicine, emergency medical services, emergency nursing, health policy and ethics, and other related topics. The journal supports the following types of articles: -Original/Research article -Systematic review/Meta-analysis -Brief report -Case-report -Letter to the editor -Photo quiz