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Dexmedetomidine versus Midazolam-Fentanyl in procedural analgesia sedation for reduction of Anterior Shoulder Dislocation: A Randomized Clinical Trial.

BACKGROUND
Shoulder joint dislocation is the most common dislocation of joints in the body. To reduce the anterior shoulder dislocation, it is necessary to have analgesia and sedation.


METHOD
In this randomized clinical trial, patients were divided into two equal groups. Group I received midazolam-fentanyl (0.05 mg/kg fentanyl at a dose of 1 μg/kg) for 10 minutes, and group II received dexmedetomidine (1 μg/kg in the initial dose and then 0.2 µg/kg/h) for 10 minutes. The levels of analgesia according to VAS criteria and the time to reach desired sedation were compared between the two groups.


RESULTS
A total of 60 patients participated in this study. The time to reach desired sedation was 8.60 ± 2.3 minutes in the dexmedetomidine group and 11.27 ± 3.57 minutes in the midazolam-fentanyl group (p= 0.001). Also, the VAS score in both midazolam-fentanyl and dexmedetomidine groups was 3.3±1.24 and 2.57±0.9, respectively. The differences were statistically significant (p=0.015). There was significant relationship between the time to reach desired sedation and the level of analgesia. Moreover, there was no significant difference between patient age and the time to reach the desired level of analgesia. During this study, no side effect was observed.


CONCLUSIONS
The findings of this study, show that dexmedetomidine provides a higher level of analgesia than midazolam-fentanyl. Moreover, it was also shown that dexmedetomidine causes a quicker procedural sedation than midazolam-fentanyl.