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Chapter 6
ABSTRACT
Background:
Pain is common during colonic insufflation required for CT colonography. We
therefore evaluated whether a single intravenous alfentanil bolus has a clinically relevant
analgesic effect compared with placebo in patients undergoing CT colonography.
Methods:
A prospective multi-centre randomised double-blind placebo-controlled trial was
performed in patients scheduled for elective CT colonography. Patients were randomised
to receive either a bolus of 7.5 μg/kg alfentanil (n=45) or placebo (n=45). The primary
outcome was the difference in maximum pain during colonic insufflation on an 11-point
numeric rating scale. We defined a clinically relevant effect as a maximum pain reduction of
at least 1.3 points. Secondary outcomes included total pain and burden of CT colonography
(5-point scale), the most burdensome aspect, and side effects. Our primary outcome was
tested using a one-sided independent samples t-test.
Results:
Maximum pain scores during insufflation were lower with alfentanil as compared
with placebo, 5.3 versus 3.0 (p<0.001). Total CT colonography pain and burden were
also lower with alfentanil (2.0 vs. 1.6; p=0.014 and 2.1 vs. 1.7; p=0.007, respectively). With
alfentanil, fewer patients rated the insufflation as most burdensome aspect (56.1% vs. 18.6%;
p=0.001). Episodes with desaturations (SpO
2
< 90%) were more common with alfentanil
(8.1% vs. 44.4%; p<0.001, but no clinically relevant desaturations occurred.
Conclusions:
A low-dose intravenous alfentanil bolus provides a clinically relevant reduction
of maximum pain during CT colonography and may improve the CT colonography
acceptance, especially for patients with a low pain threshold.