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Comparative Study
. 2014 Feb;15(1):76-80.
doi: 10.5811/westjem.2013.7.15616.

Comparison of procedural sedation for the reduction of dislocated total hip arthroplasty

Jonathan E Dela Cruz  1 , Donald N Sullivan  2 , Eric Varboncouer  2 , Joseph C Milbrandt  3 , Myto Duong  1 , Scott Burdette  1 , Daniel O'Keefe  1 , Steven L Scaife  4 , Khaled J Saleh  2
Affiliations
Comparative Study

Comparison of procedural sedation for the reduction of dislocated total hip arthroplasty

Jonathan E Dela Cruz et al. West J Emerg Med. 2014 Feb.

Abstract

Introduction: Various types of sedation can be used for the reduction of a dislocated total hip arthroplasty. Traditionally, an opiate/benzodiazepine combination has been employed. The use of other pharmacologic agents, such as etomidate and propofol, have more recently gained popularity. Currently no studies directly comparing these sedation agents have been carried out. The purpose of this study is to compare differences in reduction and sedation outcomes, including recovery times, of these 3 sedation agents.

Methods: We performed a retrospective chart review examining 198 patients who presented with dislocated total hip arthroplasty at 2 academic affiliated medical centers. The patients were grouped according to the type of sedation agent. We calculated percentages of reduction and sedation complications along with recovery times. Reduction complications included fracture, skin or neurovascular injury, and failure of reduction requiring general anesthesia. Sedation complications included use of bag-valve mask and artificial airway, intubation, prolonged recovery, use of a reversal agent, and inability to achieve sedation. We then compared the data for each sedation agent.

Results: We found reduction complications rates of 8.7% in the propofol, 24.7% in the etomidate, and 28.9% in the opiate/benzodiazepine groups. The propofol group was significantly different from the other 2agents (p ≤ 0.01). Sedation complications were found 7.3% of the time in the propofol , 11.7% in the etomidate , and 21.3% in the opiate/benzodiazepine group, (p=0.02 propofol vs. others) . Average recovery times were 25.2 minutes for propofol, 30.8 minutes for etomidate, and 44.4 minutes for opiate/benzodiazepine (p = 0.05 for propofol vs. other agents).

Conclusion: For reduction of dislocated total hip arthroplasty under procedural sedation, propofol appears to have fewer complications and a trend toward more rapid recovery than both etomidate and opiate/benzodiazepine. These data support the use of propofol as first line agent for procedural sedation of dislocated total hip arthroplasty, with fewer complications and a shorter recovery period.

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Conflict of interest statement

Conflicts of Interest: By the WestJEM article submission agreement, all authors are required to disclose all affiliations, funding sources and financial or management relationships that could be perceived as potential sources of bias. The authors disclosed none.

References

    1. Morrey BF. Instability after total hip arthroplasty. Orthop Clin North Am. 1992;23(2):237–248. - PubMed
    1. Alberton GM, High WA, Morrey BF. Dislocation after revision total hip arthroplasty : an analysis of risk factors and treatment options. J Bone Joint Surg Am. 2002;84-A(10):1788–1792. - PubMed
    1. Frymann SJ, Cumberbatch GL, Stearman AS. Reduction of dislocated hip prosthesis in the emergency department using conscious sedation: a prospective study. Emerg Med J. 2005;22(11):807–809. - PMC - PubMed
    1. Gagg J, Jones L, Shingler G et al. Door to relocation time for dislocated hip prosthesis: multicentre comparison of emergency department procedural sedation versus theatre-based general anaesthesia. Emerg Med J. 2009;26(1):39–40. - PubMed
    1. Germann CA, Geyer DA, Perron AD. Closed reduction of prosthetic hip dislocation by emergency physicians. Am J Emerg Med. 2005;23(6):800–805. - PubMed

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