Comparing Conscious Sedation Modalities for Closed Reduction of Traumatic Native Hip Dislocations
Dale Bongbong, Benjamin Lurie, Matthew Siow, Brendon Mitchell, William T. Kent
University of California, San Diego, School of Medicine
Department of Orthopaedic Surgery, University of California, San Diego
Traumatic native hip dislocations pose a risk of avascular necrosis of the femoral head if not promptly reduced. Closed reduction is frequently attempted under conscious procedural sedation with various sedative agents. However, no studies to date have examined the relative efficacy of these agents at achieving reduction. We therefore sought to compare the efficacy of conscious sedation with propofol versus combination fentanyl/midazolam for closed reduction of traumatic native hip dislocations. A retrospective review was conducted to identify patients with a native hip dislocation at a Level I trauma center. The type, dose and timing of sedative agents used for conscious sedation were documented, as were any complications relating to either the sedation or the attempted reduction. The primary outcome was frequency of successful closed reduction compared between patients sedated with propofol versus fentanyl/midazolam. Time to reduction was defined as the time elapsed from start of sedation to radiographic evidence of successful reduction. In the propofol group, there were significantly more successful closed hip reductions per total attempts, lower odds of failure, significantly less median time to reduction, and no difference in sedation-related complication than in the fentanyl/midazolam group. To our knowledge, this is the first study to compare the efficacy of common sedative agents in achieving closed reduction for traumatic native hip dislocations. Our findings suggest that conscious sedation with adequate propofol dosing is significantly more effective than, and should therefore be favored over, combination fentanyl/midazolam for the closed reduction of native hip dislocations.
Keywords: trauma, sedation, orthopaedics