Carbon dioxide insufflation during ERCP for reduction of postprocedure pain: a randomized, double-blind, controlled trial
| Autor: | John T. Maple, Esmat Z. Saddedin, David M. Thompson, Rajesh N. Keswani, Lawrence Waldbaum, Sreenivasa S. Jonnalagadda, R. Mark Hovis, Clint Hagen, Riad R. Azar, Steven A. Edmundowicz |
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| Rok vydání: | 2009 |
| Předmět: |
Adult
Male Insufflation medicine.medical_specialty Abdominal pain Randomization Visual analogue scale Nausea law.invention Young Adult Double-Blind Method Randomized controlled trial law medicine Humans Radiology Nuclear Medicine and imaging Aged Aged 80 and over Cholangiopancreatography Endoscopic Retrograde Pain Postoperative business.industry Gastroenterology Carbon Dioxide Middle Aged Abdominal distension medicine.disease Obstructive lung disease Surgery Anesthesia Female medicine.symptom business |
| Zdroj: | Gastrointestinal Endoscopy. 70:278-283 |
| ISSN: | 0016-5107 |
| DOI: | 10.1016/j.gie.2008.12.050 |
| Popis: | Background Abdominal pain after ERCP is common, and although it is frequently nonspecific and self-limited, it may provoke concern for complications and thus distress both patients and physicians. Carbon dioxide (CO 2 ) insufflation during ERCP may reduce abdominal distension in comparison to insufflation of air, resulting in less pain. Objective To compare the incidence and severity of post-ERCP pain in patients receiving CO 2 versus air insufflation during ERCP. Design Randomized, double-blind, controlled trial. Setting University medical center. Patients This study involved consecutive patients presenting for ERCP, excluding those with significant preprocedure pain or obstructive lung disease. Intervention Randomization to insufflation with air or CO 2 ; all other care was identical. Main Outcome Measurements Pre-ERCP and post-ERCP pain and nausea were assessed by using a 0 to 10 visual analogue scale. Patient waist circumferences were measured before and after procedures. Results One hundred patients (82 outpatients, 51 women, mean age 54.4 years, 50 randomized to CO 2 ) completed the study. The CO 2 and air groups were similar in regard to demographics, indication for ERCP, and procedure duration. The mean pain score 1 hour post-ERCP was higher with air than with CO 2 insufflation (1.9 vs 0.7, P = .01). Similarly, the incidence of any pain at 1 hour post-ERCP was higher with air than with CO 2 (48% vs 28%, P = .04). The mean increase in waist circumference was greater with air than with CO 2 (2.1 cm vs 0.3 cm, P = .003). Adverse events were infrequent and did not differ by group. No serious cardiopulmonary complications occurred. Limitations Single-center, selected patient population. Conclusion Insufflation of CO 2 during ERCP reduces postprocedure pain and abdominal distension in comparison to insufflation of air. The use of CO 2 in deeply sedated, prone patients appears to be safe. |
| Databáze: | OpenAIRE |
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