Spinal anesthesia versus ketamine-based procedural sedation for emergency orthopedic reductions in the emergency department: a systematic review and evidence synthesis

Mazi Mohammed Alanazi; Reema Abdulrahman Bin Klaib; Ghala Tariq Alsuwaina; Jumanah Omar Altamimi; Mohammed Humayd Al-githami; Waleed Ahmed Alenezi; Raghad Ahmed Al Johani; Sari Salem Alqahtani; Othman Yaqoub Aldayhan; Ammar Abdullah Alsabilah

doi:10.24911/IJMDC.51-1760815897

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Online Published: 29 Nov 2025

IJMDC. 2025; 9(10): 2577-2583

doi: 10.24911/IJMDC.51-1760815897

Spinal anesthesia versus ketamine-based procedural sedation for emergency orthopedic reductions in the emergency department: a systematic review and evidence synthesis

Mazi Mohammed Alanazi, Reema Abdulrahman Bin Klaib, Ghala Tariq Alsuwaina, Jumanah Omar Altamimi, Mohammed Humayd Al-githami, Waleed Ahmed Alenezi, Raghad Ahmed Al Johani, Sari Salem Alqahtani, Othman Yaqoub Aldayhan, Ammar Abdullah Alsabilah.

Abstract
Emergency orthopedic reductions in the emergency department (ED) require short-acting anesthesia or sedation that ensures analgesia, immobility, and rapid recovery with minimal cardiopulmonary risk. This systematic review synthesized comparative studies of ED sedation regimens (ketamine-, propofol-, etomidate-, and benzodiazepine opioid-based, with or without ketamine–propofol) for fracture and large-joint reductions and frames these findings alongside perioperative evidence relevant to neuraxial anesthesia. Seven original comparative studies met the inclusion criteria for results synthesis. Procedural success was high in regimens. Ketamine reduced hypoxia, myoclonus, and airway maneuvers compared with etomidate during large-joint reductions, while propofol shortened recovery compared with ketamine or ketamine/midazolam in several settings. Ketamine and propofol provided small gains in recovery time and less emesis versus ketamine alone in pediatrics. Although ED trials of spinal anesthesia for bedside reductions are sparse, perioperative hip-fracture data showed no superiority of spinal over general anesthesia for survival or ambulation, and dose-optimization might mitigate neuraxial hypotension in older adults. Multiple pharmacologic pathways enable safe, effective ED reductions; technique selection should be individualized to patient factors, staff expertise, and throughput goals.

Key words: Emergency department, orthopedic reduction, procedural sedation, ketamine, spinal anesthesia, systematic review

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Pubmed Style

Alanazi MM, Klaib RAB, Alsuwaina GT, Altamimi JO, Al-githami MH, Alenezi WA, Johani RAA, Alqahtani SS, Aldayhan OY, Alsabilah AA. Spinal anesthesia versus ketamine-based procedural sedation for emergency orthopedic reductions in the emergency department: a systematic review and evidence synthesis. IJMDC. 2025; 9(10): 2577-2583. doi:10.24911/IJMDC.51-1760815897

Web Style

Alanazi MM, Klaib RAB, Alsuwaina GT, Altamimi JO, Al-githami MH, Alenezi WA, Johani RAA, Alqahtani SS, Aldayhan OY, Alsabilah AA. Spinal anesthesia versus ketamine-based procedural sedation for emergency orthopedic reductions in the emergency department: a systematic review and evidence synthesis. https://www.ijmdc.com/?mno=291219 [Access: December 09, 2025]. doi:10.24911/IJMDC.51-1760815897

AMA (American Medical Association) Style

Alanazi MM, Klaib RAB, Alsuwaina GT, Altamimi JO, Al-githami MH, Alenezi WA, Johani RAA, Alqahtani SS, Aldayhan OY, Alsabilah AA. Spinal anesthesia versus ketamine-based procedural sedation for emergency orthopedic reductions in the emergency department: a systematic review and evidence synthesis. IJMDC. 2025; 9(10): 2577-2583. doi:10.24911/IJMDC.51-1760815897

Vancouver/ICMJE Style

Alanazi MM, Klaib RAB, Alsuwaina GT, Altamimi JO, Al-githami MH, Alenezi WA, Johani RAA, Alqahtani SS, Aldayhan OY, Alsabilah AA. Spinal anesthesia versus ketamine-based procedural sedation for emergency orthopedic reductions in the emergency department: a systematic review and evidence synthesis. IJMDC. (2025), [cited December 09, 2025]; 9(10): 2577-2583. doi:10.24911/IJMDC.51-1760815897

Harvard Style

Alanazi, M. M., Klaib, . R. A. B., Alsuwaina, . G. T., Altamimi, . J. O., Al-githami, . M. H., Alenezi, . W. A., Johani, . R. A. A., Alqahtani, . S. S., Aldayhan, . O. Y. & Alsabilah, . A. A. (2025) Spinal anesthesia versus ketamine-based procedural sedation for emergency orthopedic reductions in the emergency department: a systematic review and evidence synthesis. IJMDC, 9 (10), 2577-2583. doi:10.24911/IJMDC.51-1760815897

Turabian Style

Alanazi, Mazi Mohammed, Reema Abdulrahman Bin Klaib, Ghala Tariq Alsuwaina, Jumanah Omar Altamimi, Mohammed Humayd Al-githami, Waleed Ahmed Alenezi, Raghad Ahmed Al Johani, Sari Salem Alqahtani, Othman Yaqoub Aldayhan, and Ammar Abdullah Alsabilah. 2025. Spinal anesthesia versus ketamine-based procedural sedation for emergency orthopedic reductions in the emergency department: a systematic review and evidence synthesis. International Journal of Medicine in Developing Countries, 9 (10), 2577-2583. doi:10.24911/IJMDC.51-1760815897

Chicago Style

Alanazi, Mazi Mohammed, Reema Abdulrahman Bin Klaib, Ghala Tariq Alsuwaina, Jumanah Omar Altamimi, Mohammed Humayd Al-githami, Waleed Ahmed Alenezi, Raghad Ahmed Al Johani, Sari Salem Alqahtani, Othman Yaqoub Aldayhan, and Ammar Abdullah Alsabilah. "Spinal anesthesia versus ketamine-based procedural sedation for emergency orthopedic reductions in the emergency department: a systematic review and evidence synthesis." International Journal of Medicine in Developing Countries 9 (2025), 2577-2583. doi:10.24911/IJMDC.51-1760815897

MLA (The Modern Language Association) Style

Alanazi, Mazi Mohammed, Reema Abdulrahman Bin Klaib, Ghala Tariq Alsuwaina, Jumanah Omar Altamimi, Mohammed Humayd Al-githami, Waleed Ahmed Alenezi, Raghad Ahmed Al Johani, Sari Salem Alqahtani, Othman Yaqoub Aldayhan, and Ammar Abdullah Alsabilah. "Spinal anesthesia versus ketamine-based procedural sedation for emergency orthopedic reductions in the emergency department: a systematic review and evidence synthesis." International Journal of Medicine in Developing Countries 9.10 (2025), 2577-2583. Print. doi:10.24911/IJMDC.51-1760815897

APA (American Psychological Association) Style

Alanazi, M. M., Klaib, . R. A. B., Alsuwaina, . G. T., Altamimi, . J. O., Al-githami, . M. H., Alenezi, . W. A., Johani, . R. A. A., Alqahtani, . S. S., Aldayhan, . O. Y. & Alsabilah, . A. A. (2025) Spinal anesthesia versus ketamine-based procedural sedation for emergency orthopedic reductions in the emergency department: a systematic review and evidence synthesis. International Journal of Medicine in Developing Countries, 9 (10), 2577-2583. doi:10.24911/IJMDC.51-1760815897

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