Comparing ketofol with etofen in procedural sedation analgesia for anterior shoulder dislocation reduction: A randomized trial.

Abstract

Anterior shoulder dislocations are common in emergency settings, requiring effective procedural sedation and analgesia (PSA). Ketofol (ketamine-propofol) and etofen (etomidate-fentanyl) are widely used, but their comparative efficacy remains debated. The aim of this study was to compare the efficacy and safety of ketofol versus etofen for PSA in shoulder dislocation reduction. This randomized clinical trial enrolled 92 patients (46 per group). Ketofol (0.75 mg/kg) or etofen (0.15 mg/kg etomidate + 1.5 µg/kg fentanyl) was administered. Outcomes included sedation depth, hemodynamics, adverse events, and recovery times. Ketofol provided deeper sedation (RSS 4.5 vs. 4.1, p < 0.001), better analgesia (VAS 1.64 vs. 2.64, p < 0.001), and easier reduction but had more emergence reactions. Etofen showed faster onset and fewer respiratory events but caused myoclonus. Ketofol offers superior analgesia and sedation, while etofen ensures rapid recovery and hemodynamic stability. The choice depends on clinical priorities. IRCT20220824055790N1.