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Effect of Sedation/Analgesia During Colonoscope on Abdominal Pain After Examination
Fong-Sheng Lin1, Chih-Peng Lin1, Ya-Jung Cheng1
1Department of Anesthesiology, National Taiwan University Hospital, Taipei, Taiwan.
Background:
Sedation/analgesia (S/A) is widely used to relieve patients' anxiety and discomfort during colonoscopy. Their effects on abdominal pain after colonoscopy have never been fully investigated.
Methods:
The prospective study consecutively recruited 494 healthy patients having a screen colonoscopy examination as part of their health checkup. They were divided into two groups based on individuals' decision to receive sedation and analgesia or not. In the S/A group, 374 patients received midazolam and alfentanil during colonoscopy with standard monitoring, while in the non-sedation/analgesia (NSA) group, 120 patients received no analgesics. Severity and duration of abdominal pain (ordinal scale: 1 = none, 4 = severe) were assessed at the end of stay in the postanesthetic care unit (the S/A group) or examination room (the NSA group) and before discharge. Side effects S/A during (hypotension, hypoxemia) and after (nausea, vomiting, dizziness) colonoscopy were also recorded. All patients were closely monitored during the whole course of the health check-up package.
Results:
The mean doses of midazolam and alfentanil were 4.06 mg and 813.12 μg, respectively. Patients in the NSA group had two-fold risks of moderate to severe abdominal pain compared to those in the S/ A group (16.67% vs. 9.36%, odds ratio = 1.937, 95% confidence interval: 1.010-3.625). The NSA group also had a higher incidence of abdominal pain 120 minutes after examination (33.33% vs. 16.04%, P < 0.001). Duration of abdominal pain in those patients who did have abdominal pain was longer in the S/ A group than in the NSA group (153.3 ± 49.9 vs. 118.7 ± 47.5 minutes, P < 0.001). The incidence of hypotension and hypoxemia in the group S/A was 5.6% and 2.9%, respectively. More patients in the S/ A group felt dizzy or sleepy than those in the NSA group (14.7% vs. 3.3%, P < 0.001). The incidence of nausea and vomiting was similar between the two groups.
Conclusion:
Optimal S/A with midazolam and alfentanil decreases the severity and duration of postcolonoscopic abdominal pain.
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