Comparison of fentanyl/midazolam with ketamine/midazolam for pediatric orthopedic emergencies.

Abstract

OBJECTIVE:

Emergency management of pediatric fractures and dislocations requires effective analgesia, yet children's pain is often undertreated. We compared the safety and efficacy of fentanyl- versus ketamine- based protocols.

METHODOLOGY:

Patients 5 to 15 years of age needing emergency fracture or joint reduction (FR) were randomized to receive intravenous midazolam plus either fentanyl (F/M) or ketamine (K/M). Measures of efficacy were observational distress scores and self- and parental-report. Measures of safety were frequency of abnormalities in and need for support of cardiopulmonary function and other adverse effects.

RESULTS:

During FR, K/M subjects (n = 130) had lower distress scores and parental ratings of pain and anxiety than did F/M subjects (n = 130). Although both regimens equally facilitated reductions, deep sedation, and procedural amnesia, orthopedists favored K/M. Recovery was 14 minutes longer for K/M. Fewer K/M subjects had hypoxia (6% vs 25%), needed breathing cues (1% vs 12%), or required oxygen (10% vs 20%) than did F/M subjects. Two K/M subjects required assisted ventilation briefly. More K/M subjects vomited. Adverse emergence reactions were rare but equivalent between regimens.

CONCLUSIONS:

During emergency pediatric orthopedic procedures, K/M is more effective than F/M for pain and anxiety relief. Respiratory complications occurred less frequently with K/M, but respiratory support may be needed with either regimen. Both regimens facilitate reduction, produce amnesia, and rarely cause emergence delirium. Vomiting is more frequent and recovery more prolonged with K/M.

• Authors: R M Kennedy, F L Porter, J P Miller, D M Jaffe
• Journal: Pediatrics (Pediatrics) Vol. 102 Issue 4 Pt 1 Pg. 956-63 (Oct 1998) ISSN: 0031-4005 [Print] United States
• PMID: 9755272 (Publication Type: Clinical Trial, Comparative Study, Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't, Research Support, U.S. Gov't, P.H.S.)

Chemical References

• Analgesics, Opioid
• Anesthetics, Dissociative
• Anti-Anxiety Agents
• Drug Combinations
• Ketamine
• Midazolam
• Fentanyl

Topics

• Adolescent
• Analgesics, Opioid (adverse effects, therapeutic use)
• Anesthetics, Dissociative (adverse effects, therapeutic use)
• Anti-Anxiety Agents (therapeutic use)
• Anxiety (drug therapy)
• Child
• Child, Preschool
• Drug Combinations
• Emergency Treatment
• Female
• Fentanyl (adverse effects, therapeutic use)
• Fractures, Bone (therapy)
• Humans
• Joint Dislocations (therapy)
• Ketamine (adverse effects, therapeutic use)
• Male
• Midazolam (therapeutic use)
• Pain (drug therapy)
• Respiration (drug effects)
• Treatment Outcome