Analgesia without sedatives during colonoscopies: worth considering?
Colonoscopy is a proven method for bowel cancer screening and is often experienced as a painful procedure. Today, there are two main strategies to facilitate colonoscopy. First, deep sedation results in satisfied patients but increases sedation-associated risks and raises costs for healthcare providers. Second, there is the advocacy for colonoscopies without any form of sedation. This might be an option for a special group of patients, but does not hold true for everybody. Following Moerman's hypothesis: "If pain is the crucial point, why do we need sedation?" this review shows the analgesic options for a painless procedure, increasing success rates without increasing risk of sedation. There are two agents, with the potential to be a nearly ideal analgesic agent for colonoscopy: alfentanil and nitrous oxide (N(2)O). Administration of either substance causes the patient to be comfortable yet alert and facilitates a short turnover. Advantages of these drugs include rapid onset and offset of action, analgesic and anxiolytic effects, ease of titration to desired level, rapid recovery, and an excellent safety profile.
Department of Anesthesiology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1100 DD, Amsterdam, The Netherlands. S.Eberl@amc.uva.nl
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Eberl
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Preckel
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Fockens
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Hollmann
D015760:Alfentanil / Q000627:therapeutic use*; D000698:Analgesia / Q000379:methods*; D018712:Analgesics, Non-Narcotic / Q000627:therapeutic use*; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D003113:Colonoscopy; D006801:Humans; D009609:Nitrous Oxide / Q000627:therapeutic use*; D010146:Pain / Q000188:drug therapy* / Q000209:etiology; D059408:Pain Management / Q000379:methods*
D018712:Analgesics, Non-Narcotic; D000701:Analgesics, Opioid; D015760:Alfentanil; D009609:Nitrous Oxide