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

Abstract 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.