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.
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.
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.
Adverse emergence reactions were rare but equivalent between regimens.
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. (...)
Mots-clés Pascal : Orthopédie, Traumatologie, Enfant, Homme, Adolescent, Etude comparative, Midazolam, Efficacité traitement, Effet secondaire, Kétamine, Association médicamenteuse, Fentanyl, Chimiothérapie, Traitement, Benzodiazépine dérivé, Opiacés, Hypnotique, Analgésique narcotique, Sédatif, Phencyclidine dérivé
Mots-clés Pascal anglais : Orthopedics, Traumatology, Child, Human, Adolescent, Comparative study, Midazolam, Treatment efficiency, Secondary effect, Ketamine, Drug combination, Fentanyl, Chemotherapy, Treatment, Benzodiazepine derivatives, Opiates, Hypnotic, Narcotic analgesic, Sedative
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 98-0511769
Code Inist : 002B02B05. Création : 23/03/1999.