Abstract

Emergency department orthopedic reductions require rapid analgesia and sedation with minimal patient disruption. This systematic review evaluated pharmacologic and regional strategies for rapid sequence analgesia and procedural sedation. Following PRISMA 2020, PubMed, Central, Elsevier (ScienceDirect), and Scopus were searched for prospective studies for patients undergoing painful orthopedic reductions in the emergency department. Eligible reports compared systemic sedative or analgesic methods, or regional nerve blocks, and reported effectiveness, time-based outcomes, or adverse events. Eight studies met the inclusion criteria. In adults, propofol-based methods shortened induction, procedure, and recovery times compared with opioid-benzodiazepine combinations, without an increase in serious respiratory or hemodynamic complications. Ultrasound-guided interscalene and suprascapular nerve blocks had similar reduction success and satisfaction to systemic sedation, but reduced length of stay and complications. Rapid sequence analgesia and procedural sedation facilitate emergency orthopedic reductions. Propofol-based strategies and ultrasound-guided nerve blocks each offer distinct advantages; system selection should be individualized to patient profile and clinician expertise.

Key words: Emergency department, procedural sedation, rapid sequence analgesia, orthopedic reduction, propofol, systematic review