Efficacy of procedural sedation and analgesia compared between propofol and diazepam before closed reduction in closed fracture of distal end radius in emergency department in King Chulalongkorn Memorial Hospital: a randomized controlled trial
Category:
Background:
Procedural sedation analgesia (PSA) offered advantages of relief of anxiety and reduction of pain in orthopedic procedure in emergency room. Propofol, as recommended by American College of Emergency Physicians, provided rapid and short duration of anxiolysis and amnesia. However, diazepam has been shown to reduce muscle spasm which may aid fracture reduction. We compared efficacy of propofol and diazepam combined with fentanyl as PSA regimen for reduction of fracture of distal end radius.
Objective:
To compared duration of sedation between propofol and diazepam in closed reduction in closed fracture distal end radius.
Method:
A single-center open-labelled non-blind randomized controlled trial of 30 patients with close fracture distal end radius was conducted at the emergency department, King Chulalongkorn Memorial Hospital (KCMH) from January 2015 to September 2015. Combination of propofol-fentanyl (PF) and diazepam-fentanyl (DF) were random for each group. PSA effect, including level of sedation and time to recovery, were recorded using Ramsay sedation score and Aldrete score retrospectively. Pain was record using visual analog score (VAS). Satisfaction point was rated by patients and orthopedist. Statistical analysis for continuous normal distribution data is two-tailed t-test, for skewed data is Mann-Whitney U test and for category data is chi-square, p value <0.05 is significant.
Results:
Thirty patients were included (15 in each group). Demographic data showed significant higher body weight in PF group (57 vs 65 kg). Sedative level was achieved in 12 patients in PF group and 2 in DF group with statistically different (p < 0.05). Starting time of procedure after injected medication in PF group was significantly lesser (2.7 vs 7.2 minutes, p = 0.003). Oxygen desaturation was found in 6 patients in PF group and 1 in DF group (p = 0.080). Amnesia was significantly higher in PF group (p<0.05; 13 patients in PF vs 0 patient in DF group). Fourteen patients in each group had achieved acceptable alignment of postreduction radiograph by first attempt. Satisfaction was significantly higher in PF group both from participants and orthopedists (p = 0.016 and 0.03 retrospectively).
Conclusion:
Propofol combined with fentanyl has shown to be the effective method of sedation for reduction distal radius fracture with higher satisfaction from both patients and doctors. Diazepam combined with fentanyl showed less sedation. However, successful rate of reduction was equal in both groups. Monitoring of oxygenation is recommended if propofol is used.