Endoscopy 2016; 48(09): 823-828
DOI: 10.1055/s-0042-108433
Original article
© Georg Thieme Verlag KG Stuttgart · New York

Routine vs. on-demand analgesia in colonoscopy: a randomized clinical trial

Øyvind Holme
1   Department of Medicine, Sørlandet Hospital, Kristiansand, Norway
2   Institute of Health and Society, University of Oslo, Oslo, Norway
,
Thomas de Lange
3   Cancer Registry of Norway, Oslo, Norway
4   Department of Medicine, Vestre Viken Hospital, Bærum, Norway
,
Asbjørn Stallemo
1   Department of Medicine, Sørlandet Hospital, Kristiansand, Norway
,
Håvard Wiig
1   Department of Medicine, Sørlandet Hospital, Kristiansand, Norway
,
Audun Hasund
1   Department of Medicine, Sørlandet Hospital, Kristiansand, Norway
,
Katrine Dvergsnes
1   Department of Medicine, Sørlandet Hospital, Kristiansand, Norway
,
Kjetil Garborg
1   Department of Medicine, Sørlandet Hospital, Kristiansand, Norway
2   Institute of Health and Society, University of Oslo, Oslo, Norway
,
Carl Magnus Ystrøm
5   Innlandet Hospital, Elverum, Norway
,
Magnus Løberg
2   Institute of Health and Society, University of Oslo, Oslo, Norway
6   Department of Transplantation Medicine and KG Jebsen Center for Colorectal Cancer Research, Oslo University Hospital, Oslo, Norway
,
Geir Hoff
2   Institute of Health and Society, University of Oslo, Oslo, Norway
3   Cancer Registry of Norway, Oslo, Norway
7   Telemark Hospital, Skien, Norway
,
Michael Bretthauer
1   Department of Medicine, Sørlandet Hospital, Kristiansand, Norway
2   Institute of Health and Society, University of Oslo, Oslo, Norway
6   Department of Transplantation Medicine and KG Jebsen Center for Colorectal Cancer Research, Oslo University Hospital, Oslo, Norway
,
Mette Kalager
2   Institute of Health and Society, University of Oslo, Oslo, Norway
6   Department of Transplantation Medicine and KG Jebsen Center for Colorectal Cancer Research, Oslo University Hospital, Oslo, Norway
8   Department of Epidemiology, Harvard T H Chan School of Public Health, Boston, United States
› Author Affiliations
Further Information

Publication History

submitted14 December 2015

accepted after revision16 April 2016

Publication Date:
15 June 2016 (online)

Background and study aims: Colonoscopy is frequently performed with opioid analgesia, but the impact of drug delivery timing has not been studied in detail. Low-dose opioids administered before the procedure may provide better pain control than on-demand administration when the patient experiences pain.

Patients and methods: A total of 119 outpatients were randomized to receive 50 μg of fentanyl either before colonoscopy (routine group) or on demand if needed during the colonoscopy (on-demand group). Additional fentanyl or midazolam was allowed in both groups if required. The primary outcome was pain measured on both a 100-mm visual analog scale (VAS; 0 = no pain, 100 = worst possible pain) and a four-point Likert scale (no, slight, moderate, or severe pain) immediately after the procedure.

Results: A total of 61 patients in the routine group and 58 patients in the on-demand group were included in the study. Mean VAS pain scores were 27.4 mm in the routine group and 30.5 mm in the on-demand group (mean difference – 3.2 mm; 95 % confidence interval – 11.9 to 5.5; P = 0.5). On the Likert scale, moderate or severe pain was experienced by 25.0 % and 31.5 % of patients in the routine and on-demand groups, respectively (p = 0.5). Cecal intubation rate and time to reach the cecum were similar between the groups. More patients in the on-demand group (81.0 %) than in the routine group (62.3 %) were able to leave the clinic without the need for recovery time (P = 0.03).

Conclusion: Routine administration of fentanyl did not provide better analgesia during colonoscopy than on-demand fentanyl, and more patients needed time for recovery.

Trial registration: ClinicalTrials.gov (NCT01786434).