Skip to main content

Comparison of meperidine plus midazolam and fentanyl plus midazolam in procedural sedation: A double-blind, randomized controlled trial

Advances in Therapy volume 21, pages 312–321 (2004)Cite this article

Abstract

This double-blind, randomized, prospective study was conducted to compare the analgesic and sedative efficacy of fentanyl and meperidine in orthopedic closed reduction of fractures and dislocations undertaken in the emergency department. Seventy consecutive adult patients with fractures or dislocations suitable for reduction were randomized to receive fentanyl (1 mcg/kg; n=36) or meperidine (0.5 mg/kg; n=34) in combination with midazolam (0.02 mg/kg). Vital signs and alertness scale scores of the patients were monitored. The Visual Analog Scale (VAS) was used to determine the degree of pain. There was no statistically significant difference between the VAS mean scores of the fentanyl and meperidine groups (t test,P=.772). The need for additional analgesic drugs was significantly more frequent in patients receiving meperidine (P=.018). No adverse events, such as hypotension or respiratory depression, were noted. Euphoria occurred in one patient in the fentanyl group. Although dose requirements differ, fentanyl and meperidine provide effective and reliable analgesia in closed reduction of fractures and dislocations.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

USD 39.95

Price includes VAT (USA)
Tax calculation will be finalised during checkout.

References

  1. Chudnofsky CR, Lozon MM. Sedation and analgesia for procedures. In: Rosen P, Barkin R, Danzl DF, Marie M.Emergency Medicine: Concepts and Clinical Practice. 4th ed. St. Louis, Mo: Mosby;1998:301–313.

    Google Scholar 

  2. Michael F, Murphy MSD. Sedation.Ann Emerg Med. 1996;27:461–463.

    Article  Google Scholar 

  3. Nicolaou DD. Systemic analgesia and sedation for procedures. In: Tintinalli JE, Kellen GD, Stapczynski JS.Emergency Medicine. 5th ed. New York, NY: McGraw-Hill; 2000:269–274.

    Google Scholar 

  4. Melzack R, Katz J. Pain measurement in persons in pain. In: Wall PD, Melzack R, eds.Textbook of Pain. 3th ed. New York, NY: Churchill Livingstone; 1994:337–351.

    Google Scholar 

  5. Wright SW, Chudnofsky CR, Dronen SC, et al. Comparison of midazolam and diazepam for conscious sedation in the emergency department.Ann Emerg Med. 1993;22:201–208.

    PubMed  Article  CAS  Google Scholar 

  6. Friedland LR, Kulick RM. Emergency department analgesic use in pediatric trauma victims with fractures.Ann Emerg Med. 1994;23:203–207.

    PubMed  Article  CAS  Google Scholar 

  7. Singer AJ, Richman PB, Kowalska A, Thode HC. Comparison of patient and practitioner assessments of pain from commonly performed emergency department procedures.Ann Emerg Med. 1999;33:652–658.

    PubMed  CAS  Google Scholar 

  8. Burton JH, Bock AJ, Strout TD, Marcolini EG. Etomidate and midazolam for reduction of anterior shoulder dislocation: a randomized, controlled trial.Ann Emerg Med. 2002;40:496–504.

    PubMed  Article  Google Scholar 

  9. Chudnofsky CR, Weber JE, Stoyanoff PJ, et al. A combination of midazolam and ketamine for procedural sedation and analgesia in adult emergency department patients.Acad Emerg Med. 2000;7:228–235.

    PubMed  Article  CAS  Google Scholar 

  10. Grant A, Hoddinott C, Evans R. Midazolam sedation for the reduction of Colles’ fractures.Injury. 1993;24:461–463.

    PubMed  Article  CAS  Google Scholar 

  11. Lerman B, Yoshida D, Levitt MA. A prospective evaluation of the safety and efficacy of methohexital in the emergency department.Am J Emerg Med. 1996;14:440.

    Article  Google Scholar 

  12. Shane SA, Susan M, Fuchs MD, Khine H. Efficacy of rectal midazolam for the sedation of preschool children undergoing laceration repair.Ann Emerg Med. 1994;24:1065–1073.

    PubMed  Article  CAS  Google Scholar 

  13. Furia JP, Alioto RJ, Marquardt JD. The efficacy and safety of the hematoma block for fracture reduction in closed, isolated fractures.Orthopedics. 1997;20:423–426.

    PubMed  CAS  Google Scholar 

  14. Terndrup TE, Dire DJ, Madden CM, et al. Comparison of intramuscular meperidine and promethazine with and without chlorpromazine.Ann Emerg Med. 1993;22:206–211.

    PubMed  Article  CAS  Google Scholar 

  15. Billmire DA, Neale HW, Gregory RO. Use of IV fentanyl in the outpatient treatment of pediatric facial trauma.J Trauma. 1985;25:1079–1080.

    PubMed  CAS  Google Scholar 

  16. Schutzman SA, Burg J, Liebelt E, et al. Oral transmucosal fentanyl citrate for premedication of children undergoing laceration repair.Ann Emerg Med. 1994;24:1059–1064.

    PubMed  Article  CAS  Google Scholar 

  17. Theroux MC, West DW, Corddry DH, et al. Efficacy of intranasal midazolam in facilitating suturing of lacerations in preschool children in the emergency department.Pediatrics. 1993; 91:624–627.

    PubMed  CAS  Google Scholar 

  18. Kanegaye JT, Favela JL, Acosta M, Bank DE. High-dose rectal midazolam for pediatric procedures: a randomized trial of sedative efficacy and agitation.Pediatr Emerg Care. 2003;19:329–336.

    PubMed  Article  Google Scholar 

  19. Jantos TJ, Paris PM, Menegazzi JJ, Yealy DM. Analgesic practice for acute orthopedic trauma pain in Costa Rican emergency departments.Ann Emerg Med. 1996;28:145–150.

    PubMed  Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Emergency Department, Dokuz Eylul University Medical School, Inciralti, 35340, Izmir, Turkey

    Suna Soysal MD, Ozgur Karcioglu MD, Ahmet Demircan MD, Hakan Topacoglu MD, Mustafa Serinken MD & Niyazi Ozucelik MD

  2. Department of Public Health, Dokuz Eylul University Medical School, Izmir, Turkey

    Kazim Tirpan MD

  3. Department of Anesthesiology, Dokuz Eylul University Medical School, Izmir, Turkey

    Ali Gunerli MD

Authors
  1. Suna Soysal MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ozgur Karcioglu MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ahmet Demircan MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Hakan Topacoglu MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Mustafa Serinken MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Niyazi Ozucelik MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Kazim Tirpan MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Ali Gunerli MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Soysal, S., Karcioglu, O., Demircan, A. et al. Comparison of meperidine plus midazolam and fentanyl plus midazolam in procedural sedation: A double-blind, randomized controlled trial. Adv Therapy 21, 312–321 (2004). https://doi.org/10.1007/BF02850035

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF02850035

Keywords

  • procedural sedation
  • orthopedic reductions
  • fentanyl
  • meperidine
  • midazolam
  • emergency department