In oral and maxillofacial outpatient surgery, sedation techniques are an important component in patient management for a wide variety of surgical procedures. Fentanyl and midazolam are commonly used sedatives with different mechanisms of action and specific analgesic or amnestic properties. We examined whether the choice of order of their administration may affect the patient’s pain perception or procedural vital signs.

Methods : We conducted a prospective, randomized, parallel group, clinical trial. Subjects were randomly assigned to either one of two intravenous sedation groups: Fentanyl group: received Fentanyl first, then Midazolam; Midazolam group: received Midazolam first then Fentanyl. Recollection of the intraoperative pain score was assessed 24 h after surgery using Wong–Baker faces pain scale. The Mann–Whitney U test was used to assess for the presence of a statistically significant difference between the two groups. Statistically significant differences in procedural vital sign fluctuations were examined. Subjects’ satisfaction with the procedure was assess and inter-group comparisons were made.

Results : A total of 66 subjects were enrolled, one of whom did not complete the study. Recollected procedural pain scores at 24 h following surgery were not statistically significantly different between groups. Median scores on the Wong–Baker faces pain scale for the two groups were: Fentanyl group 2.0 (IQR 3.1); Midazolam group 1.5 (IQR 2.5) with a p value of 0.333. There was no significant difference in the change in vital signs from baseline to two surgical end points among the two groups. Subject satisfaction did not differ between the two groups.

Conclusions : Selective sequencing of initial midazolam or fentanyl sedation did not result in a measurable difference of recollected procedural pain scores at 24 h following 3rd molar extraction. The choice of sedation and order of its administration should be tailored to the patient’s needs, type of the surgical procedure, and surgeon preference.