Two dosages of remifentanil for patient-controlled analgesia vs. meperidine during colonoscopy: A prospective randomized controlled trial

Background and study: Combined use of opiates and benzodiazepines often results in delayed discharge after colonoscopy. Aims: To compare sedation quality of two dosages of patient controlled analgesia remifentanil with one another and with that of a midazolam-meperidine association during colonoscopy. Methods: Ninety patients undergoing colonoscopy were randomly assigned to three groups. Group M received a meperidine bolus (0.7. mg/kg) and sham patient controlled analgesia. Group R1 received remifentanil 0.5. μg/kg and group R2 remifentanil 0.8. μg/kg together with a patient-controlled analgesia pump injecting further boluses (2-min lock-out). Technical difficulties of the examination, gastroenterologist's and patient's satisfaction with sedoanalgesia were evaluated after colonoscopy on a 100. mm Visual Analogue Scale. Patient's satisfaction was assessed 24. h later. Results: Group M had more adverse events ( p= 0.044), required more rescue boluses ( p= 0.0010), had lower Observer's Assessment of Alertness and Sedation Scale score at the end of the procedure ( p= 0.0016) and longer discharge time ( p= 0.0001). Groups R1 and R2 did not differ with respect to these variables. Patient's degree of pain and satisfaction with sedo-analgesia, endoscopist's technical difficulty and satisfaction were not different among groups. Conclusions: Remifentanil patient controlled analgesia is a safe approach to sedation for colonoscopy.