Remifentanil vs. Meperidine for Patient-Controlled Analgesia During Colonoscopy: A Randomized Double-Blind Trial

Fanti, Lorella; Aglietta, Massimo; Gemma, Marco; Giulia, Gambino; Facciorusso, Antonio; Guslandi, Mario; Torri, G.; Alberto, Testoni Pier

doi:10.1038/ajg.2009.53

Cited by 29 publications

(29 citation statements)

References 21 publications

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“…A number of approaches have been utilized to minimize pain and discomfort during and after colonoscopy, including use of CO 2 for insufflation, improving the analgesic regimen, providing technical aids, and patient controlled sedation [8] or analgesia [15]. As the interval from administration of pharmacologic agents to commencement of the colonoscopy is variable, sufficient time may not be given for the drugs to exert their effects.…”

Section: Introductionmentioning

confidence: 99%

Brain measures of nociception using near-infrared spectroscopy in patients undergoing routine screening colonoscopy

Becerra

Aasted

Boas

et al. 2016

Pain

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Colonoscopy is an invaluable tool for screening and diagnosis of many colonic diseases. For most colonoscopies, moderate sedation is used during the procedure. However, insufflation of the colon produces a nociceptive stimulus that is usually accompanied by facial grimacing/groaning while under sedation. The objective of the current study was to evaluate whether a nociceptive signal elicited by colonic insufflation could be measured from the brain. Seventeen otherwise healthy patients (age 54.8±9.1; 6 female) undergoing routine colonoscopy (i.e., no history of significant medical conditions) were monitored using near-infrared spectroscopy (NIRS). Moderate sedation was produced using standard clinical protocols for midazolam and meperidine, titrated to effect. NIRS data captured during the procedure was analyzed offline to evaluate the brains’ responses to nociceptive stimuli evoked by the insufflation events (defined by physician or observing patients’ facial responses). Analysis of NIRS data revealed a specific, reproducible prefrontal cortex activity corresponding to times when patients grimaced. The pattern of the activation is similar to that previously observed during nociceptive stimuli in awake healthy individuals, suggesting that this approach may be used to evaluate brain activity evoked by nociceptive stimuli under sedation, when there is incomplete analgesia. While some patients report recollection of procedural pain following the procedure, the effects of repeated nociceptive stimuli in surgical patients may contribute to postoperative changes including chronic pain. The results from this study indicate that NIRS may be a suitable technology for continuous nociceptive afferent monitoring in patients undergoing sedation and could have applications under sedation or anesthesia.

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Section: Introductionmentioning

confidence: 99%

Brain measures of nociception using near-infrared spectroscopy in patients undergoing routine screening colonoscopy

Becerra

Aasted

Boas

et al. 2016

Pain

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“…It is also comparable with the consumption of remifentanil when IVPCA is employed for analgesia and sedation during painful procedures such as colonoscopy (Ackaboy et al 2006, Fanti et al 2009). In comparison with papers reporting consumption of remifentanil during labour analgesia, the parturients in the current study used remifentanil in the lowest range (Volikas et al 2005, Balcioglu et al 2007, D'Onofrio et al 2009), most probably reflecting the fact that remifentanil was only used for a short time in the current study, whereas the other studies employed remifentanil for the 92 entire duration of labour.…”

Section: Dosing Of Remifentanil In Labour Analgesiamentioning

confidence: 61%

Intravenous patient-controlled analgesia with remifentanil in early labour

Volmanen¹

2011

Acta Anaesthesiologica Scandinavica

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Cover design Raimo Ahonen JUVENES PRINT TAMPERE 2010Volmanen, Petri, Intravenous patient controlled analgesia with remifentanil in early labour. AbstractIn four prospective clinical trials, 114 parturients used intravenous patient-controlled remifentanil analgesia during the 1 st stage of labour. The median effective dose per bolus was ascertained to be 0.4 μg/kg and the pain scores were reduced with this by a median of 2 on a numerical scale (0-10). Compared with nitrous oxide, 15 parturients included in a cross-over study reported a larger reduction in pain scores during remifentanil analgesia (1.5 vs. 0.5, p = 0.001) and better pain relief scores (2.5 vs. 0.5 on a ranked five point scale 0-4, p < 0.001). In a parallel study including 45 parturients, epidural analgesia (EDA, 20 ml bupivacaine 0.625 mg/ml and fentanyl 2 μg/ml) was associated with lower pain scores (5.2 vs. 7.3 with remifentanil, p = 0.004) but variables related to satisfaction with analgesia (pain relief score, proportion of mothers with desire to continue with the given medication and termination of the study due to inadequate pain relief) were similar. A comparison of two methods for timing the remifentanil bolus during the uterine contraction cycle suggested that delaying the bolus does not improve analgesia. A period effect was noted in the cross-over trial with higher pain scores and increased drug consumption during the second study period suggesting acute hyperalgesia.Side effects of remifentanil analgesia included respiratory depression warranting oxygen supplementation in 33% of parturients. Sedation was experienced by the parturients using remifentanil and this was scored as stronger than sedation during nitrous oxide and EDA. The number of parturients with nausea did not increase during remifentanil analgesia. Other maternal side effects included dizziness, a difficulty in visual focusing and itching. Foetal heart rate tracing abnormalities were noted. The incidence of abnormal tracings and decreased UapH were not different, however, from that observed during nitrous oxide or EDA. Apgar scores at 1 and 5 minute indicated no neonatal depression. Keywords

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“…These techniques have been shown to be effective methods for pain control during gastrointestinal endoscopy. 51,52 However, not all patients are willing to take responsibility for their own sedation. CAPS uses feedback from real-time measures of drug effect (for example, blood pressure, heart rate, oxygen saturation, end-tidal carbon dioxide [the level of carbon dioxide released at the end of expiration] and patients reaction to tactile stimuli or BIS) to control propofol infusion.…”

Section: Reviewsmentioning

confidence: 99%

“…50 For the newer, ultra-short-acting opiates (for example, remifentanil and alfentanil), which are similar in structure and potency to fentanyl but with a more rapid onset and duration, no significant benefit in comparison to standard sedation/analgesia regimens has been demonstrated yet. 51,52 Ketamine…”

Section: Pethidine Hydrochloridementioning

confidence: 99%

How best to approach endoscopic sedation?

Müller

Wehrmann

2011

Nat Rev Gastroenterol Hepatol

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Sedation is the drug-induced reduction of a patient's consciousness. The aim of sedation in endoscopic procedures is to increase the patient's comfort and to improve endoscopic performance, especially in therapeutic procedures. The most commonly used sedation regimen for conscious sedation in gastrointestinal endoscopy is still the combination of benzodiazepines with opioids. However, the use of propofol has increased enormously in the past decade and several studies show advantages of propofol over the traditional regimes in terms of faster recovery time. It is important to be aware that the complication rate of endoscopies increases when sedation is used; therefore, a thorough risk evaluation before the procedure and monitoring during the procedure must be performed. In addition, properly trained staff and emergency equipment should be available. The best approach to sedation in endoscopy is to choose a sedation regimen for the individual patient, tailored according to the clinical risk assessment and the anxiety level of the patient, as well as to the type of planned endoscopic procedure.

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Remifentanil vs. Meperidine for Patient-Controlled Analgesia During Colonoscopy: A Randomized Double-Blind Trial

Abstract: Remifentanil PCA is safe and effective to induce sedoanalgesia during colonoscopy. Further studies should address the optimization of dosing and lock out setting.

Cited by 29 publications

References 21 publications

Brain measures of nociception using near-infrared spectroscopy in patients undergoing routine screening colonoscopy

Brain measures of nociception using near-infrared spectroscopy in patients undergoing routine screening colonoscopy

Intravenous patient-controlled analgesia with remifentanil in early labour

How best to approach endoscopic sedation?

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