From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Yes, painful procedures performed outside of operating rooms typically require either sedating agents with analgesic properties, local anesthetic infiltration at the incision site, or the services of an anesthesiology staff member. For moderate sedation, a combination of medications like midazolam (1-2 mg IV) and fentanyl (25-50 mcg IV) is commonly used, with doses titrated to the patient's response, as seen in a study comparing ketamine/propofol versus midazolam/fentanyl for procedural sedation and analgesia 1. For local anesthesia, lidocaine (1-2%, maximum 4.5 mg/kg) or bupivacaine (0.25-0.5%, maximum 2 mg/kg) can be infiltrated at the procedure site. Procedures that cause significant pain or require deep sedation should involve anesthesiology personnel for patient safety, as supported by a study on low-dose fentanyl, propofol, midazolam, ketamine, and lidocaine combination versus regular dose propofol and fentanyl combination for deep sedation induction 2. The appropriate approach depends on the procedure's invasiveness, anticipated pain level, patient factors (age, comorbidities), and institutional protocols. This requirement exists because pain management during procedures is essential for patient comfort and cooperation, while proper monitoring is necessary to prevent and manage potential complications like respiratory depression or cardiovascular instability, as highlighted in a study on the effects of intravenous ketorolac and fentanyl combined with midazolam on analgesia and side effects during extracorporeal shock wave lithotripsy 3. Additionally, the use of sedating agents with analgesic properties, such as ketorolac, can provide adequate analgesia and reduce the need for narcotics, as shown in a study comparing sodium diclofenac, ketamine, and propofol with fentanyl and midazolam in balanced anesthesia 4. Overall, the most recent and highest quality study, 2, supports the use of sedating agents with analgesic properties and/or local anesthetic infiltration at the incision site, or the services of an anesthesiology staff member for painful procedures performed outside of operating rooms.