The utilisation of procedural sedation and analgesia at a regional hospital emergency department in KwaZulu-Natal

Abstract

Background: Procedural sedation and analgesia (PSA) is a core competency of emergency medicine physicians. Although international guidelines and research have advanced considerably, limited data exist on PSA practice in South African emergency departments, particularly within KwaZulu-Natal.
Methods: We conducted a retrospective review of documented PSA practice at Dr Pixley Ka Isaka Seme Memorial Hospital (DPKISMH) between 01 June 2024 and 01 June 2025. Demographic data, clinical indications, preprocedural preparation, monitoring standards, drug class use, and complications were extracted from procedural sedation forms and patient records. Descriptive statistics were applied to summarise findings.
Results: A total of 165 documented cases of PSA were analysed. Orthopaedic manipulations accounted for the majority of procedures (69.7%), followed by burn wound care (16.3%) and intercostal drain placement (7.9%). Patients were predominantly young adults without comorbidities, though the cohort spanned a broad age range from 18 months to 87 years. Preprocedural preparation revealed variable fasting status, with supplemental oxygen applied in most cases. Ketamine was the predominant agent, frequently supplemented with opioids for analgesia. Monitoring adhered to the Emergency Medicine Society of South Africa (EMSSA) recommendations, with most cases documented as conducted under a three-provider model. Documented complications were mild and transient, with no aspiration or vomiting reported in this cohort.
Conclusion: This study reviewed documented PSA practices in a regional emergency department (ED) in KwaZulu-Natal, describing patient demographics, clinical indications, preprocedural preparation and monitoring standards, drug class use, and complication frequency.
Contribution: The findings provide a baseline for understanding current practice and highlight areas for further development and research across South African emergency departments.