The effect of anesthesia on post-colonoscopy abdominal pain
Date Issued
2007
Date
2007
Author(s)
Wu, Chia-Chan
DOI
zh-TW
Abstract
Background:
Colonoscopy is a powerful tool to screen and diagnose colon cancer. However, the residual gas used for extending colon usually results in abdominal discomfort after examination. Several methods including using CO2 instead of air for insufflation or total colonic decompression after colonoscopy were tried to decrease post-colonoscopy abdominal discomfort with different degree of success. It appears that the residual gas in the colon plays a major role in the persistence of abdominal pain. GABA, opioid, and NMDA receptors which are the targets of commonly used anesthetics, were found to be involved with the transmission of colon distension pain and the formation of visceral hyperalgesia in animal model. Anesthesia has been known to decrease the patients’ discomfort during colonoscopy but its effect on post-colonoscopy abdominal pain is yet to be clarified.
Objective:
In this study, we try to find out whether midazolam and alfentanil, as GABA and opioid receptor agonist respectively, used for sedation in colonoscopy, has any role in decreasing severity, incidence, or duration of post-colonoscopy abdominal pain. We also investigate if ketamine, promising in decreasing visceral hyperalgesia in human and animal models, had any impact in pain from colon distension after colonoscopy when used as an adjunct of anesthesia.
Methods:
The study recruited healthy patients having screen colonoscopy examination as part of their health checkup. In the first phase of study, we prospectively collected data of patients who chose to receive anesthesia or not by themselves. For those having anesthesia, midazolam and alfentanil were given during colonoscopy while those declining anesthesia received no analgesics or anesthetics. Severity (ordinal scale: 1=none, 4=severe) and duration of abdominal pain were recorded after exam and repeatedly measured during their stay in hospital. Side effects of anesthesia (nausea, vomiting, dizziness) colonoscopy were also recorded.
In the second phase, the patients willing to have anesthesia were randomized to receive ketamine 0.2mg/kg or not after midazolam and alfentanil. The data about abdominal pain and anesthetic side effects were recorded as in the first phase.
Result:
The first phase enrolled 494 patients, including 374 with anesthesia and 120 without anesthesia. The anesthesia group had a higher proportion of women and the history of abdominal surgery (43.6% vs. 29.2%; 28.3% vs. 16.6%). While the incidence of abdominal discomfort including all degrees didn’t differ between the two groups, anesthesia did cause reduction in the incidence of moderate to severe pain (9.63% vs. 16.67%, p=0.026). In those did have abdominal discomfort, the duration was shorter with anesthesia (118.7±47.5 vs. 153.3 ±49.9minutes, p<0.001). The difference in the incidence of all abdominal pain became greater as the time progressed and was largest roughly at 120 minutes after exam (16.03% vs. 33.33%, p=0.026). Anesthesia didn’t produce higher incidence of side effect except dizziness (14.7% vs. 3.3%). Analyzing the influence on the risk of abdominal pain 120 minutes after exam by multivariate logistic regression, we found that anesthesia, but not the history of abdominal surgery, gender and the duration of colonoscopy, would decrease the risk (odds ratio 0.43, 95% confidence interval 0.26 ~ 0.73).
In the second phase, we recruited 151 patients receiving standard anesthesia and another 127 patients having additional ketamine. The characteristics including age, gender distribution, height, weight, incidence of abdominal surgery and total exam time were not different in these two groups. While producing more frequent vomiting and dizziness (3.15% vs. 0%, p=0.042; 18.11% vs. 9.27%, p=0.031), 0.2mg/kg ketamine didn’t decrease the incidence of abdominal pain or the pain duration (56.69% vs. 54.3%, p=0.69; 121.55 ± 70.07 min vs. 108.93 ± 38.1 min, p= 0.172).
Conclusions: Anesthesia with midazolam and alfentanil would reduce the severity and duration of abdominal pain after colonoscopy. The addition of ketamine had no effect on abdominal pain and induced more side effects.
Subjects
大腸鏡
疼痛
麻醉
colonoscopy
pain
anesthesia
SDGs
Type
other
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