Aim To investigate analgesic and side effects of different doses of fentanyl in combination with propofol for colonoscopy. Methods This prospective randomized double-blind study conducted between 2019 and 2020 included 64 patients. Patients were randomized: Group 1 (fentanyl 0.5 μg/kg) and Group 2 (fentanyl 1.0 μg/kg) both in combination with propofol. Ramsay sedation score (RSS) was obtained at 5 with an additional dose of propofol. The primary outcome was the patient’s postprocedural pain and adverse events during and after the procedure. Results The RSS means were statistically lower for Group 2 at the beginning and every 5 minutes of the procedure. Mean arterial pressure (MAP) for Group 2 (first, 5, 25 and 30 min) was significantly lower (p=0.000, and heart rate (HR) was significantly higher for Group 1 (during the entire procedure) (p=0.000) than in another group; peripheral oxygen saturation (SpO2 ) was significantly lower for measurements within both groups (Group 1, 5, 10, 15 min; Group 2, 5, 10,15 min) (p=0.000 and p=0.000, respectively). Anxiety (p=0.010), weakness (p=0.000) and confusion (p=0.023) proved to be significantly higher for Group 1, and hypotension (p=0.001) for Group 2 than in another group. No statistical significance of Visual Analogue Pain Scale (VAS) (p=0.501) and Aldrete recovery score (ARS) (p=0.845) was found. Conclusion There was no significance in postprocedural abdominal pain between the group of patients administered fentanyl at a dose of 0.5 μg/kg and the group of patients administered fentanyl at a dose of 1.0 μg/kg; however, prevalence of complications was more significant in the group with a fentanyl at a dose of 0.5 μg/kg.
Holme Ø, Bretthauer M. Pain and sedation during colonoscopy -a never ending story. Endosc Int Open. 2016. p. 538–9.
2.
Chan B, Hussey A, Rubinger N, Hookey L. Patient comfort scores do not affect endoscopist behavior during colonoscopy, while trainee involvement has negative effects on patient comfort. Endosc Int Open. 2017. p. 1259–67.
3.
Bugajski M, Wieszczy P, Hoff G, Rupinski M, Regula J, Kaminski M. Modifiable factors associated with patient-reported pain during and after screening colonoscopy. Gut. 2018. p. 1958–64.
4.
Allen P, Shaw E, Jong A, Behrens H, Skinner I. Severity and duration of pain after colonoscopy and gastroscopy: a cohort study. J Clin Nurs. 2015. p. 1895–903.
5.
Baudet J, Diaz-Bethencourt D, Avile´s J, Aguirre-Jaime A. Minor adverse events of colonoscopy on ambulatory patients: the impact of moderate sedation. Eur J Gastroenterol Hepatol. 2009. p. 6.
6.
Elphick D, Donnelly M, Smith K, Riley S. Factors associated with abdominal discomfort during colonoscopy: a prospective analysis. Eur J Gastroenterol Hepatol. 2009. p. 1076–82.
7.
Trevisani L, Zelante A, Sartori S, Colonoscopy. pain and fears: Is it an indissoluble trinomial? World J Gastrointest Endosc. 2014. p. 227–33.
8.
Leung F. Methods of Reducing Discomfort During Colonoscopy. Dig Dis Sci. 2008. p. 1462–7.
9.
Lam SC, Castelo C, Tinmouth M, Llovet J, Kishibe D, Baxter T, et al. Non-pharmacological interventions to improve the patient experience of colonoscopy under moderate or no sedation: a systematic review protocol. BMJ Open. 2020. p. 38621.
10.
Grilo-Bensusan I, Herrera-Martín P, Jiménez-Mesa R, Aguado-Álvarez V. Prospective study of the factors associated with poor tolerance to ambulatory colonoscopy under conscious sedation. Rev Esp Enferm Dig. 2018. p. 223–30.
11.
Lazaraki G, Kountouras J, Metallidis S, Dokas S, Bakaloudis T, Chatzopoulos D, et al. Single use of fentanyl in colonoscopy is safe and effective and significantly shortens recovery time. Surg Endosc. 2007. p. 1631–6.
12.
Hirsh I, Vaissler A, Chernin J, Segol O, Pizov R. Fentanyl or tramadol, with midazolam, for outpatient colonoscopy: analgesia, sedation, and safety. Dig Dis Sci. 2006. p. 1946–51.
13.
Perez-Maña C, Fontanet P, Fonseca E, Farré F, Torrens A, Farre M, et al. Drug interactions with new synthetic opioids. Front Pharmacol. 2018. p. 1145.
14.
Friesgaard K, Nikolajsen L, Giebner M, Rasmussen C, Riddervold I, Kirkegaard H, et al. Efficacy and safety of intravenous fentanyl administered by ambulance personnel. Acta Anaesthesiol Scand. 2016. p. 537–43.
15.
Schug S, Ting S. Fentanyl formulations in the management of pain: an update. Drugs. 2017. p. 747–63.
16.
Shingina A, Ou G, Takach O, Svarta S, Kwok R, Tong J, et al. Identification of factors associated with sedation tolerance in 5000 patients undergoing outpatient colonoscopy: Canadian tertiary center experience. World J Gastrointest Endosc. 2016. p. 770–6.
17.
Soral M, Altun G, Dinçer P, Arslantaş M, Aykaç Z. Effectiveness of the analgesia nociception index monitoring in patients who undergo colonoscopy with sedo-analgesia. Turk J Anaesthesiol Reanim. 2020. p. 50–7.
18.
Wadelek J. Medications commonly used for analogizations during a colonoscopy. Br J Gastroenterol. 2020. p. 168–73.
19.
Lin O. Sedation for routine gastrointestinal endoscopic procedures: a review on efficacy, safety, efficiency, cost and satisfaction. Intest Res. 2017. p. 456–66.
20.
Doyle D, Goyal A, Garmon E. American Society of Anesthesiologists Classification. StatPearls. Treasure Island. StatPearls Publishing; 2022.
21.
Singh S, Prakash K, Sharma S, Dhakate G, Bhatia V. Comparison of propofol alone and in combination with ketamine or fentanyl for sedation in endoscopic ultrasonography. Korean J Anesthesiol. 2018. p. 43–7.
22.
Sherif S, Sultan. Patient-controlled sedation with propofol/remifentanil versus propofol/alfentanil for patients undergoing outpatient colonoscopy, a randomized, controlled double-blind study. Saudi J Anaesth. 2014. p. 36–40.
23.
Grossi L, Cappello G, Marzio L. Premedication with tramadol in patients undergoing colonoscopy: a double-blind randomized placebo-controlled study. Dig Dis Sci. 2004. p. 1641–5.
24.
Hayee B, Dunn J, Loganayagam A, Wong M, Saxena V, Rowbotham D, et al. Midazolam with meperidine or fentanyl for colonoscopy: results of a randomized trial. Gastrointest Endosc. 2009. p. 681–7.
25.
Fleischman R, Frazer D, Daya M, Jui J, Newgard C. Effectiveness and safety of fentanyl compared with morphine for out-of-hospital analgesia. Prehosp Emerg Care. 2010. p. 167–75.
26.
Khan K, Fergani H, Ganguli S, Jalali S, Spaziani R, Tsoi K, et al. The benefit of fentanyl in effective sedation and quality of upper endoscopy: a double-blinded randomized trial of fentanyl added to midazolam versus midazolam alone for sedation. J Can Assoc Gastroenterol. 2019. p. 86–90.
27.
Amornyotin S, Srikureja W, Chalayonnavin W, Kongphlay S. Dose requirement and complications of diluted and undiluted propofol for deep sedation in endoscopic retrograde cholangiopancreatography. Hepatobiliary Pancreat Dis Int. 2011. p. 313–8.
28.
Mahiswar A, Dubey P, Ranjan A. Comparison between dexmedetomidine and fentanyl bolus in attenuating the stress response to laryngoscopy and tracheal intubation: a randomized double-blind trial. Braz J Anesthesiol. 2022. p. 103–9.
29.
Seleem W, Hossieny E, K. Abd-Elsalam S. Evaluation of different sedatives for colonoscopy. Curr Drug Saf. 2019.
30.
Das Neves J, Das Neves A, Araújoa P, Ferreiraa F, C, Duartea N, et al. Colonoscopy sedation: clinical trial comparing propofol and fentanyl with or without midazolam. Rev Bras Anestesiol. 2016. p. 231–6.
31.
Amornyotin S. Sedation-related complications in gastrointestinal endoscopy. World J Gastrointest Endosc. 2013. p. 527–33.
32.
Manta R, Tremolaterra F, Arezzo A, Verra M, Galloro G, Dioscoridi L, et al. Complications during colonoscopy: prevention, diagnosis, and management. Tech Coloproctol. 2015. p. 505–13.
33.
Li S, Yu F, Zhu H, Yang Y, Yang L, Lian J. The median effective concentration (EC50) of propofol with different doses of fentanyl during colonoscopy in elderly patients. BMC Anesthesiology. 2016. p. 24.
34.
Thompson R, Seck V, Riordan S, Wong S. Comparison of the effects of midazolam/fentanyl, midazolam/propofol, and midazolam/fentanyl/propofol on cognitive function after gastrointestinal endoscopy. Surg Laparosc Endosc Percutan Tech. 2019. p. 441–6.
35.
Arakawa H, Kaise M, Sumiyama K, Saito S, Suzuki T, Tajiri H. Does pulse oximetry accurately monitor a patient’s ventilation during sedated endoscopy under oxygen supplementation. Singapore Med J. 2013. p. 212–5.
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