Comparison of different Ketofol procedural sedation and analgesic doses during orthopedic procedures in patients referred to the Emergency Department; A double-blinded randomized clinical trial

Abstract

Background Orthopedic procedures are one of the most common medical procedures in the Emergency Department (ED) and are also among the painful procedures performed on the conscious patient. Objectives The aim of this study was to compare different doses of Ketofol in procedural sedation and analgesia in patients referred to the EDs. Methods In this double-blinded clinical trial, 296 patients aged 18 years or over presented with need of orthopedic procedures in the three academic EDs in 2020 were studied. After completing the written consent, the patients were randomly assigned into four treatment groups. Demographic information, underlying diseases, patients' physical condition, type of orthopedic injuries requiring intervention, patients' vital signs were recorded in a checklist for each patient. Results In this study, the mean age, gender, level of education, addiction, patients' physical condition, type of procedures performed, apnea, hypoventilation, bradycardia, hypotension and agitation in all four treatment groups were not statistically different, but hallucination and hypoxia in group C (1: 3) were much less than other groups thus oxygen administration was more common in other groups. Conclusion By testing different doses of ketamine, we came to the conclusion that doses of 1 mg and 0.5 mg were associated with more side effects. Dose of 0.33 mg of ketamine, has fewer side effects while causing analgesia and sedation as in the above doses. Dose of 0.25 mg ketamine increases the likelihood of requiring subsequent doses. Therefore, it seems that 0.33 mg of ketamine is the best dose of choice.

Keywords

• Orthopedic procedures
• Ketofol
• Procedural Sedation and Analgesia (PSA)
• Pain intensity