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


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).


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


BACKGROUND
ClinicalTrials.gov (NCT01786434).
Department of Medicine, Sørlandet Hospital, Kristiansand, Norway.
Øyvind
Ø
Holme
Cancer Registry of Norway, Oslo, Norway.
Thomas
T
de Lange
Department of Medicine, Sørlandet Hospital, Kristiansand, Norway.
Asbjørn
A
Stallemo
Department of Medicine, Sørlandet Hospital, Kristiansand, Norway.
Håvard
H
Wiig
Department of Medicine, Sørlandet Hospital, Kristiansand, Norway.
Audun
A
Hasund
Department of Medicine, Sørlandet Hospital, Kristiansand, Norway.
Katrine
K
Dvergsnes
Department of Medicine, Sørlandet Hospital, Kristiansand, Norway.
Kjetil
K
Garborg
Innlandet Hospital, Elverum, Norway.
Carl Magnus
CM
Ystrøm
Institute of Health and Society, University of Oslo, Oslo, Norway.
Magnus
M
Løberg
Institute of Health and Society, University of Oslo, Oslo, Norway.
Geir
G
Hoff
Department of Medicine, Sørlandet Hospital, Kristiansand, Norway.
Michael
M
Bretthauer
Institute of Health and Society, University of Oslo, Oslo, Norway.
Mette
M
Kalager
D000368:Aged; D000698:Analgesia / Q000379:methods*; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D000762:Anesthesia Recovery Period; D002432:Cecum; D003113:Colonoscopy / Q000009:adverse effects*; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage*; D006801:Humans; D007430:Intraoperative Care; D007441:Intubation, Gastrointestinal; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D010146:Pain / Q000209:etiology / Q000517:prevention & control*; D010147:Pain Measurement; D011300:Preoperative Care
D000701:Analgesics, Opioid; D005283:Fentanyl