Mohammad Reza Moharrami - Associated Professor of Orthopedics, Department of Orthopedics, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
Mahdi Nazari - Assistant Professor of Anesthesiology, Department of Anesthesiology, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran

Introduction: This systematic review aims to compare the efficacy and safety of low-dose intravenous ketamine-midazolam with intravenous morphine for pain control in patients with hand fractures. By synthesizing the available evidence, we seek to provide clinicians with valuable insights into the potential benefits and limitations of these analgesic strategies, aiding in informed decision-making for optimal pain management in this patient population. Material and Methods: This systematic review follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to ensure transparency and methodological rigor in the review process. Results: The primary outcome of pain control was assessed using various pain scales, including the Visual Analog Scale (VAS) and Numeric Rating Scale (NRS). The majority of studies reported comparable pain control between low-dose ketamine-midazolam and intravenous morphine. Both analgesic regimens resulted in significant pain reduction. A subset of studies demonstrated that low-dose ketamine-midazolam provided superior pain control compared to intravenous morphine, particularly in the immediate post-intervention period. However, the overall evidence regarding the superiority of one regimen over the other was inconclusive due to variations in study designs, sample sizes, and outcome measures. Conclusion: Low-dose intravenous ketamine-midazolam and intravenous morphine are both effective analgesic regimens for pain control in patients with hand fractures. While the evidence regarding the superiority of one regimen over the other remains inconclusive, low-dose ketamine-midazolam appears to offer comparable pain control with reduced opioid consumption anda favorable safety profile.

Ketamine, Midazolam, Morphine, pain control, hand fracture