Eight RCTs (n=1,086) were included in the review. Sample sizes ranged from 28 to 283.
Patients treated with ketamine-midazolam compared with fentanyl-midazolam, reported significantly reduced OSBD, parental reported pain and anxiety, and orthopedists’ satisfaction (one RCT, n=260). In another RCT (n=113) patients who received ketamine-midazolam treatment had significantly longer sedation and recovery time than patients treated with propofol-fentanyl.
Patients treated with 3mg/kg lidocaine bier blocks compared to 1.5mg/kg lidocaine bier blocks reported significantly less pain (one RCT, n=283), particularly when the fracture was completely displaced. Another RCT (n=249) reported significantly less pain for patients who received 3mg/kg lidocaine bier blocks compared to those who received 3mg/kg prilocaine. There were no significant differences in pain for patients who received 50% nitrous oxide compared with lidocaine bier block (one RCT, n=24) or meperidine with promethazine (one RCT, n=30). Patients treated with nitrous oxide had a significantly shorter total procedure time than those who received bier block with lidocaine (one RCT) or meperidine (one RCTs).
Adverse events: One RCT (n=260) reported patients treated with ketamine-midazolam were less likely to have hypoxia, need breathing cues or require oxygen than those who received fentanyl-midazolam, but vomiting was more common in the ketamine group. Patients who received ketamine-midazolam had significantly fewer desaturation events and required fewer airway manoeuvres than those who received treatment with propofol-fentanyl (One RCT, n=113).
Further results were reported in the review.