Low-Dose Fentanyl, Propofol, Midazolam, Ketamine and Lidocaine Combination Vs. Regular Dose Propofol and Fentanyl Combination For Deep Sedation Induction; A Randomized Clinical Trial

Introduction: need for procedural sedation and analgesia (psa) is felt in emergency department (ed) more and more each day. this study aimed to compare the effectiveness of low-dose fentanyl, propofol, midazolam, ketamine and lidocaine combination with regular dose of propofol and fentanyl combination for induction of deep sedation. methods: in this single-blind clinical trial, candidate patients for sedation and analgesia aged more than 15 and less than 60 years old, with pain score ≥6 were allocated to one of the groups using block randomization and were compared regarding onset of action, recovery time, and probable side effects. results: 125 patients with the mean age of 37.8 ± 14.3 years were randomly allocated to each group. 100% of the patients in group 1 (5 drugs) and 56.5% of the patients in group 2 (2 drugs) were deeply sedated in the 3rd minute after injection. the 2 groups were significantly different regarding onset of action (p = 0.440), recovery time (p = 0.018), and treatment failure (p < 0.001). conclusion: low-dose fentanyl, propofol, midazolam, ketamine and lidocaine combination was more successful in induction of deep sedation compared to regular dose of propofol and fentanyl combination. recovery time was a little longer in this group and both groupswere similar regarding drug side effects and effect on vital signs.