Document Detail

Remifentanil vs. meperidine for patient-controlled analgesia during colonoscopy: a randomized double-blind trial.
MedLine Citation:
PMID:  19337241     Owner:  NLM     Status:  MEDLINE    
OBJECTIVES: The aim was to compare patients' and endoscopists' satisfaction in terms of efficacy and safety of remifentanil patient-controlled analgesia (PCA) during colonoscopy with that of a combination of midazolam and meperidine. METHODS: Sixty patients undergoing colonoscopy were randomly assigned to two groups. All of the patients received midazolam 0.03 mg/kg intravenously for premedication. In the remifentanil group, a bolus dose of remifentanil was given, and a patient-controlled sedation analgesia (PCSA) pump was set to inject further bolus doses with no "lockout" time. Patients in the meperidine group received a bolus of meperidine and sham PCSA. Non-invasive arterial blood pressure, electrocardiography, and pulse oximetry were monitored throughout the study. The Observer's Assessment of Alertness and Sedation Scale (OAA/S) was performed at baseline, every 5 min during, and after colonoscopy. Assessment of pain and satisfaction with sedoanalgesia was scheduled after colonoscopy and 24-72 h later by a 100 mm visual analog scale (VAS). The technical difficulty of the examination and the gastroenterologist's satisfaction were assessed similarly. RESULTS: The degree of pain, the level of satisfaction with sedoanalgesia by patients and gastroenterologists, and the degree of difficulty experienced by the endoscopist were not different in the two groups. The time to reach an Aldrete score > or = 9 was significantly shorter in the remifentanil group (P < 0.0001); discharge times did not differ between the groups (P = 0.36). There was no difference between the groups regarding the duration of colonoscopy (P = 0.82) and the stability of vital signs. At the end of the procedure, OAA/S was significantly higher in the remifentanil group (P = 0.03). CONCLUSIONS: Remifentanil PCA is safe and effective to induce sedoanalgesia during colonoscopy. Further studies should address the optimization of dosing and lock out setting.
Lorella Fanti; Massimo Agostoni; Agostoni Massimo; Marco Gemma; Gemma Marco; Giulia Gambino; Gambino Giulia; Antonio Facciorusso; Facciorusso Antonio; Mario Guslandi; Guslandi Mario; Giorgio Torri; Torri Giorgio; Pier Alberto Testoni; Testoni Pier Alberto
Publication Detail:
Type:  Comparative Study; Journal Article; Randomized Controlled Trial     Date:  2009-03-31
Journal Detail:
Title:  The American journal of gastroenterology     Volume:  104     ISSN:  1572-0241     ISO Abbreviation:  Am. J. Gastroenterol.     Publication Date:  2009 May 
Date Detail:
Created Date:  2009-05-06     Completed Date:  2009-06-15     Revised Date:  2009-06-23    
Medline Journal Info:
Nlm Unique ID:  0421030     Medline TA:  Am J Gastroenterol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1119-24     Citation Subset:  IM    
Department of Gastroenterology, Vita-Salute University of Milano, IRCCS H. San Raffaele, Milano, Italy.
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MeSH Terms
Analgesia, Patient-Controlled / methods*
Analysis of Variance
Anesthesia Recovery Period
Colonoscopy / methods*
Conscious Sedation / methods*
Dose-Response Relationship, Drug
Double-Blind Method
Infusions, Intravenous
Midazolam / administration & dosage*
Middle Aged
Observer Variation
Pain Measurement
Patient Satisfaction
Prospective Studies
Reference Values
Risk Factors
Sensitivity and Specificity
Reg. No./Substance:
0/Piperidines; 132875-61-7/remifentanil; 57-42-1/Meperidine; 59467-70-8/Midazolam
Erratum In:
Am J Gastroenterol. 2009 Jun;104(6):1613
Note: Massimo, Agostoni [corrected to Agostoni, Massimo]; Marco, Gemma [corrected to Gemma, Marco]; Giulia, Gambino [corrected to Gambino, Giulia]; Antonio, Facciorusso [corrected to Facciorusso, Antonio]; Mario, Guslandi [corrected to Guslandi, Mario]; Giorgio, Torri [corrected to Torri, Giorgio]; Alberto, Testoni Pier [corrected to Testoni, Pier Alberto]

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