Abstract

DE LEONARDIS CAPELO, Daniel; PREGO PETIT, Javier; BELLO PEDROSA, Osvaldo  and  PUJADAS FERRER, Mónica. Analgesia y sedación en procedimientos ortopédicos dolorosos en la sala de urgencias pediátricas. Arch. Pediatr. Urug. [online]. 2006, vol.77, n.4, pp.361-367. ISSN 1688-1249.

Summary Introduction: the use of analgesia and sedation in pain treatment is increasing in the Pediatric Emergency Department, however it has not been overexposed yet. There is no agreement about which drug association is more effective and safer to use. Objective: to evaluate safeness and efficacy of three different therapies for painful orthopedic procedures performed in children at the emergency department. Methods: a prospective, randomized clinical trial was done with patients between December 2001 and January 2003 at the emergency department.Three different therapies were compared: midazolam/fentanyl (M-F), lydocaine/propofol//fentanyl (L-P-F) and atropine/midazolam/ketamine (A-M-K). The efficacy was assessed by comparing sedation-analgesia degrees during the procedure, the need to repeat doses, pain scores post-procedure, pain reduction scores and amnesia of the procedure. Safety was assessed by considering the following adverse effects: SatO₂ decrease, apnea, bradycardia, arterial hypotension, intra-procedure hallucinations and behavioral changes after procedure. Results: sixty-one patients were included in the study and randomly distributed into three groups: 20 M-F, 20 A-M-K and 21 in L-P-F. Age, gender and weight distribution along with the kind of injury and pain scores done previously to the procedure were comparable. High sedation-analgesia scores were obtained with all the protocols with no differences found between them. 98,4% of the patients did not recall the procedure. SatO₂ decrease was observed in 16,4% of the cases prevailling in the L-P-F group. The A-M-K group had the lowest number of adverse effects (p: 0,02-RR 0,19; [0,03 to 1,34]; IC 95%). In all cases adverse effects were overcome with basic support measures. Conclusions: the three protocols were highly effective and safe. No difference was observed between them.

Keywords : ORTHOPEDIC PROCEDURES; ANALGESIA-methods; HYPNOTICS AND SEDATIVES; EMERGENCY SERVICE, HOSPITAL.

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