Sedation for interventional gastrointestinal endoscopic procedures: Are we overlooking the "pain"?

Background Although interventional gastrointestinal (GI) endoscopic procedures are known to cause greater pain and discomfort than diagnostic procedures, the efficacy of adequate pain control or the difference in pain and amount of analgesic required according to type of intervention is not well known. This study was done to investigate the safety and efficacy of combining fentanyl with propofol for interventional GI endoscopic procedures and determine whether this method is superior to propofol monosedation. Methods The data of 810 patients that underwent interventional GI endoscopic procedures under sedation with either propofol alone (Group P, n = 499) or propofol/ fentanyl (Group PF, n = 311) at a single tertiary-care hospital between May 2012 and December 2012 were retrospectively reviewed. Rates of respiratory and cardiovascular events, propofol and fentanyl requirements, and risk factors of respiratory events of the two groups were analyzed. Results The incidence of respiratory events (P = 0.001), number of cases in which the procedure had to be interrupted for assisted mask bagging (P = 0.044), and propofol infusion rates were significantly lower in Group PF compared to Group P (p < 0.0001). The amount of fentanyl required for diagnostic procedures was significantly lower than that for interventional procedures (p < 0.001). Patients of Group PF showed a lower risk of developing respiratory events compared to Group P (OR 0.224, 95 % CI 0.069-0.724). Conclusions Combining fentanyl with propofol seems to reduce the risk of respiratory events compared with propofol monosedation during GI endoscopic procedures by providing effective analgesia.