Women require routine opioids to prevent painful colonoscopies: a randomised controlled trial

Abstract

Background: Women are at high risk for painful colonoscopy. Pain, but also sedation, are barriers to colorectal cancer (CRC) screening participation. In a randomised controlled trial, we compared ondemand with pre-colonoscopy opioid administration to control pain in women at CRC screening age. Methods: Women, aged 55-79 years, attending colonoscopy at two Norwegian endoscopy units were randomised 1:1:1 to (1) fentanyl on-demand, (2) fentanyl prior to colonoscopy, or (3) alfentanil ondemand. The primary endpoint was procedural pain reported by the patients on a validated four-point Likert scale and further dichotomized for the study into painful (moderate or severe pain) and nonpainful (slight or no pain) colonoscopy. Secondary endpoints were: willingness to repeat colonoscopy, adverse events, cecal intubation time and rate, and post-procedure recovery time. Results: Between June 2017 and May 2020, 183 patients were included in intention-to-treat analyses in the fentanyl on-demand group, 177 in the fentanyl prior to colonoscopy group, and 179 in the alfentanil on-demand group. Fewer women receiving fentanyl prior to colonoscopy reported a painful colonoscopy compared to those who were given fentanyl on-demand (25.2% vs. 44.1%, p < .001). There was no difference in the proportion of painful colonoscopies between fentanyl on-demand and alfentanil on-demand (44.1% vs. 39.5%, p ¼ .40). No differences were observed for adverse events or any of the other secondary endpoints between the three groups. Conclusions: Fentanyl prior to colonoscopy provided better pain control than fentanyl or alfentanil on-demand. Fentanyl before colonoscopy should be recommended to all women at screening age. Trial registration: Clinicaltrials.gov (NCT 01538550). Norwegian Medicines Agency (16/16266-13). EU Clinical Trials Register (EUDRACTNR. 2016-005090-13) ARTICLE HISTORY

Comparison of the Safety and Efficacy of Remimazolam Besylate versus Dexmedetomidine for Patients Undergoing Fiberoptic Bronchoscopy: A Prospective, Randomized Controlled Trial

“…The incidence of respiratory depression is relatively high when alfentanil is used alone, whereas fewer instances of respiratory depression occur when propofol is used with alfentanil. 35 However, alfentanil (5 μg/kg) cannot be administered immediately before a propofol infusion due to hypoxemia induction risks. 36 Immediate injections of 5–10 µg/kg of alfentanil before the infusion of propofol or midazolam caused significant hypoxemia in another study, but the incidence of respiratory depression was significantly reduced after a 5 min interval.…”

Risk Factors Associated with Painful Colonoscopy and Prolonged Cecal Intubation Time in Female Patients

“…To overcome this issue, several strategies have been reported to reduce the pain and cecal intubation time during colonoscopy, such as the water exchange technique [11][12][13], use of a small-caliber colonoscope [14][15][16][17], sedation [18,19], and modified bowel preparation regimens [20]. However, these strategies also have certain disadvantages.…”

“…Strategies to prevent severe pain and prolonged cecal intubation time during colonoscopy in female patients have been developed and reported in previous works; these include the use of water-exchange intubation techniques [11][12][13], smallcaliber colonoscopes [14][15][16][17], sedation [18,19], and modified bowel preparation regimens [20]. However, these strategies also have certain disadvantages, such as longer cecal intubation time, poor manipulation, adverse effects, or higher costs [13,[20][21][22][23].…”