Intravenous paracetamol for persistent pain after endoscopic mucosal resection discriminates patients at risk of adverse events and those who can be safely discharged

Lobke Desomer; David J. Tate; Leshni Pillay; Halim Awadie; Mayenaaz Sidhu; Golo Ahlenstiel; Michael J. Bourke

doi:10.1055/a-2022-6530

Endoscopy, Table of Contents

Endoscopy 2023; 55(07): 611-619
DOI: 10.1055/a-2022-6530

Original article

Intravenous paracetamol for persistent pain after endoscopic mucosal resection discriminates patients at risk of adverse events and those who can be safely discharged

Lobke Desomer‡^‡

¹Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, New South Wales, Australia

²Department of Gastroenterology and Hepatology, AZ Delta Hospital, Roeselare, Belgium

³Department of Gastroenterology and Hepatology, University Hospital of Ghent, Ghent, Belgium

,

David J. Tate ‡^‡

¹Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, New South Wales, Australia

³Department of Gastroenterology and Hepatology, University Hospital of Ghent, Ghent, Belgium

⁴Westmead Clinical School, University of Sydney, Sydney, New South Wales, Australia

,

Leshni Pillay

¹Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, New South Wales, Australia

,

Halim Awadie

¹Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, New South Wales, Australia

,

Mayenaaz Sidhu

¹Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, New South Wales, Australia

,

Golo Ahlenstiel

¹Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, New South Wales, Australia

,

Michael J. Bourke

¹Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, New South Wales, Australia

⁴Westmead Clinical School, University of Sydney, Sydney, New South Wales, Australia

› Author Affiliations

Abstract

Introduction The frequency and severity of abdominal pain after endoscopic mucosal resection (EMR) of colonic laterally spreading lesions (LSLs) of ≥ 20 mm is unknown, as are the risk factors to predict its occurrence. We aimed to prospectively characterize pain after colonic EMR , determine the rapidity and frequency of its resolution after analgesia, and estimate the frequency of needing further intervention.

Methods Procedural and lesion data on consecutive patients with LSLs who underwent EMR at a single tertiary referral center were prospectively collected. If pain after colonic EMR, graded using a visual analogue scale (VAS), lasted > 5 minutes, 1 g of paracetamol was administered. Pain lasting > 30 minutes lead to clinical review and upgrade to opiate analgesics. Investigations and interventions for pain were recorded.

Results 67/336 patients (19.9 %, 95 %CI 16.0 %–24.5 %) experienced pain after colonic EMR (median VAS 5, interquartile range 3–7). Multivariable predictors of pain were: lesion size ≥ 40 mm, odds ratio [OR] 2.15 (95 %CI 1.22–3.80); female sex, OR 1.99 (95 %CI 1.14–3.48); and intraprocedural bleeding requiring endoscopic control, OR 1.77 (95 %CI 0.99–3.16). Of 67 patients with pain, 51 (76.1 %, 95 %CI 64.7 %–84.7 %) had resolution of their “mild pain” after paracetamol and were discharged without sequelae. The remaining 16 (23.9 %) required opiate analgesia (fentanyl), after which 11/16 patients (68.8 %; “moderate pain”) could be discharged. The 5/67 patients (7.5 %) with “severe pain” had no resolution despite fentanyl; all settled during hospital admission (median duration 2 days), intravenous analgesia, and antibiotics.

Conclusion Pain after colonic EMR occurs in approximately 20 % of patients and resolves rapidly and completely in the majority with administration of intravenous paracetamol. Pain despite opiates heralds a more serious scenario and further investigation should be considered.

Full Text

References

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Supplementary Material

Supplementary material