Ps. Jewell et al., PATIENT-CONTROLLED ANALGESIA FOR CONSCIOUS SEDATION DURING ENDOSCOPICRETROGRADE CHOLANGIOPANCREATOGRAPHY - A RANDOMIZED CONTROLLED TRIAL, Gastrointestinal endoscopy, 43(5), 1996, pp. 490-494
Background: Adequate comfort is essential to patients undergoing invas
ive procedures. This study was designed to evaluate whether patient-co
ntrolled analgesia could improve sedation for ERCP. Methods: Patients
were randomized to receive standard sedation (n = 31) or patient-contr
olled analgesia (n = 31). The patients were blinded to the randomizati
on. After the procedure the patient, physician, and nurse each rated t
heir satisfaction with sedation using a verbal rating scale. Results:
There was no significant difference between the patient's mean satisfa
ction score for the conventional and patient-controlled analgesia grou
ps (9.3 and 9.6, respectively, p = 0.5). The physicians rated sedation
higher in the conventional group compared with the patient-controlled
analgesia group (8.6 and 8.2, respectively, p = 0.02). Physicians' an
d nurses' scores correlated (r = 0.53, p = 0.0001), but there was no c
orrelation between scores reported by either physicians or nurses and
the patients' scores (r = 0.2 and r = 0.05, respectively). Oxygen satu
ration less than 90% occurred for more than 1 minute in three patients
who received standard sedation but in none who used patient-controlle
d analgesia. Conclusion: This trial demonstrates that patient-controll
ed analgesia during ERCP is as effective as standard sedation with res
pect to patient satisfaction. Physicians and nurses, however, are not
good proxies for assessing patient satisfaction.