PATIENT-CONTROLLED ANALGESIA FOR CONSCIOUS SEDATION DURING ENDOSCOPICRETROGRADE CHOLANGIOPANCREATOGRAPHY - A RANDOMIZED CONTROLLED TRIAL

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.