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ANALGESIA WITHOUT SEDATIVES DURING COLONOSCOPIES: WORTH CONSIDERING?
5
INTRODUCTION
Screening by colonoscopy is a proven instrument for early diagnosis of colorectal cancer.
This is an important reason, why colonoscopies belong to the most performed endoscopic
procedures. In the Netherlands, there was a 64% increase in colonoscopies from 2004 until
2009.
1
However, motivating patients to participate in colonoscopy screening continues to
be a challenge.
The lack of knowledge among patients about the nature of colonoscopy may be an
important barrier, limiting patients to accept and undergo such a screening procedure.
Commonly, colonoscopy is associated with anxiety and pain. Additionally, patients
complain over disruption of normal daily activities by bowel preparation, hangover effects
from sedation,
2
and the need for an escort after the procedure.
3
Dominitz et al.
4
stated
that 25% of patients who never have had a colonoscopy before are willing to surrender
median 90 days of their life to avoid the screening procedure. However, after having had a
colonoscopy, this number decreased to almost zero days.
Pain and discomfort during colonoscopy
Activation of sensory nerves by stretching the sigmoid wall due to looping of the coloscope
or over-insufflation with air triggers pain that is typical for colonoscopies.
5
This visceral pain
often aggravates due to its autonomous components, e.g. sweating, bradycardia, dizziness,
hypotension, and nausea.
Pain is not only a physical reaction of the body, but it also has mental and behavioural
components associated with former experiences and cultural background, which often
seems to be resistant to analgesic treatments. Pain is less tolerated by younger, often slender
females and is better accepted in the older generation. Unfortunately, it is yet impossible to
predict, how painful the examination for the individual patient will be.
Sedation for colonoscopy
Sedation for colonoscopy is currently a matter of discussion; In the United States (US),
sedation has become standard for colonoscopies. Depending on the study, either moderate
or deep sedation is favoured. Other parts of the world advocate for completely medication-
free colonoscopies.
6-10
In one US study, only 16.9% (n=73) patients would accept sedation-free colonoscopy.
11
However, another study reported that in 23% of patients unsedated colonoscopies could
be performed with excellent patient satisfaction and acceptable comfort level.
12
Eckardt et
al.
7
showed in a study on 2.500 patients, that 95% of all patients could undergo colonoscopy
without sedation when experienced colonoscopists and optimal equipment was present.
Unfortunately, the authors did not report data on patient satisfaction. Nowadays, use of