Remifentanil Versus Fentanyl/Midazolam in Painless Reduction of Anterior Shoulder Dislocation; A Randomized Clinical Trial

Introduction: performance of painful diagnostic and therapeutic procedures is common in emergency department (ed), and procedural sedation and analgesia (psa) is a fundamental skill for every emergency physician. this studywas aim to compare the efficacy of remifentanil with fentanyl/midazolam in painless reduction of anterior shoulder dislocation. methods: in this randomized, double blind, clinical trial the procedural characteristics, patients satisfaction as well as adverse events were compared between fentanyl/midazolamand remifentanil for psa of 18–64 years old patients, which were presented to ed following anterior shoulder dislocation. results: 96 cases were randomly allocated to two groups (86.5% male). there were no significant difference between groups regarding baseline characteristics. remifentanil group had lower duration of procedure (2.5±1.6 versus 4.6±1.8 minutes, p < 0.001), higher pain reduction (53.7±13.3 versus 33.5±19.6, p < 0.001), lower failure rate (1 (2.1%) versus 15 (31.3%), p < 0.001), higher satisfaction (p= 0.005). adverse events were seen in 12 (25%) patients in midazolam/fentanyl and 8 (16.7%) cases in remifentanil group (p = 0.122). conclusion: it seems that use of remifentanil resulted in lower procedural time, lower failure rate, and lower pain during procedure as well as higher patient satisfaction in comparison with midazolam/fentanyl combination in anterior shoulder dislocation.