A comparison allowing rescue fentanyl is not a test of never using fentanyl.
In an elective cardiac-catheterization study, reported pain scores were similar for initial midazolam alone and midazolam plus fentanyl. Eleven patients assigned to midazolam monotherapy crossed over to receive fentanyl.
The study was small and single-center, used patient questionnaires and allowed rescue treatment. Similar average pain scores do not prove that every patient can comfortably complete the procedure without an opioid.
Report the rescue provision alongside the group outcome. Distinguish an initial strategy with optional escalation from an absolute prohibition. The study cannot establish that midazolam itself provides equivalent analgesia or resolve whether rescue medication was appropriate in an individual procedure.
Source: PMC8355996, supplied full-text paper. Findings are paraphrased; forensic implications are an interpretation.
Related: A Synthetic Cannabinoid Enhanced Clonazepam but Not Clobazam in One Mouse Seizure Model.