Procedural sedation and analgesia for percutaneous trans-hepatic biliary drainage: Randomized clinical trial for comparison of two different concepts
Procedural sedation and analgesia (PSA) is important during painful dilatation and stenting in patients undergoing percutaneous trans-hepatic biliary drainage (PTBD). A prospective, nonblinded randomized clinical trial was performed comparing different analgesic regimens with regard to the patient’s...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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De Gruyter
2020-08-01
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| Series: | Open Medicine |
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| Online Access: | https://doi.org/10.1515/med-2020-0220 |
| _version_ | 1818718305172586496 |
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| author | Zanvettor Alex Lederer Wolfgang Glodny Bernhard Chemelli Andreas P. Wiedermann Franz J. |
| author_facet | Zanvettor Alex Lederer Wolfgang Glodny Bernhard Chemelli Andreas P. Wiedermann Franz J. |
| author_sort | Zanvettor Alex |
| collection | DOAJ |
| description | Procedural sedation and analgesia (PSA) is important during painful dilatation and stenting in patients undergoing percutaneous trans-hepatic biliary drainage (PTBD). A prospective, nonblinded randomized clinical trial was performed comparing different analgesic regimens with regard to the patient’s comfort. Patients were randomly assigned to two treatment groups in a parallel study, receiving either remifentanil or combined midazolam, piritramide, and S-ketamine. The primary study endpoint was pain intensity before, during, and after the intervention using the numerical rating scale (0, no pain; 10, maximum pain). The secondary study endpoint was the satisfaction of the interventional radiologist. Fifty patients underwent PTBD of whom 19 (38.0%) underwent additional stenting. During intervention, the two groups did not differ significantly. After the intervention, the need for auxiliary opioids was higher (12.5% vs 7.7%; p = 0.571) and nausea/vomiting was more frequently observed (33.4% vs 3.8%; p = 0.007) in patients with remifentanil than in patients with PSA. Overall, 45 patients (90.0%) needed additional administration of non-opioid analgesics during postinterventional observation. Remifentanil and combined midazolam, piritramide, and S-ketamine obtained adequate analgesic effects during PTBD. After the intervention, medications with antiemetics and long-acting analgesics were more frequently administered in patients treated with remifentanil (EudraCT No. 2006-003285-34; institutional funding). |
| first_indexed | 2024-12-17T19:48:56Z |
| format | Article |
| id | doaj.art-19af10ac7b904324b08c6a08d1c95c93 |
| institution | Directory Open Access Journal |
| issn | 2391-5463 |
| language | English |
| last_indexed | 2024-12-17T19:48:56Z |
| publishDate | 2020-08-01 |
| publisher | De Gruyter |
| record_format | Article |
| series | Open Medicine |
| spelling | doaj.art-19af10ac7b904324b08c6a08d1c95c932022-12-21T21:34:48ZengDe GruyterOpen Medicine2391-54632020-08-0115181582110.1515/med-2020-0220med-2020-0220Procedural sedation and analgesia for percutaneous trans-hepatic biliary drainage: Randomized clinical trial for comparison of two different conceptsZanvettor Alex0Lederer Wolfgang1Glodny Bernhard2Chemelli Andreas P.3Wiedermann Franz J.4Department of Anesthesiology and Critical Care Medicine, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, AustriaDepartment of Anesthesiology and Critical Care Medicine, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, AustriaDepartment of Radiology, Medical University of Innsbruck, Innsbruck, AustriaDepartment of Radiology, Landesklinikum Baden-Moedling, Baden Moedling, AustriaDepartment of Anesthesiology and Critical Care Medicine, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, AustriaProcedural sedation and analgesia (PSA) is important during painful dilatation and stenting in patients undergoing percutaneous trans-hepatic biliary drainage (PTBD). A prospective, nonblinded randomized clinical trial was performed comparing different analgesic regimens with regard to the patient’s comfort. Patients were randomly assigned to two treatment groups in a parallel study, receiving either remifentanil or combined midazolam, piritramide, and S-ketamine. The primary study endpoint was pain intensity before, during, and after the intervention using the numerical rating scale (0, no pain; 10, maximum pain). The secondary study endpoint was the satisfaction of the interventional radiologist. Fifty patients underwent PTBD of whom 19 (38.0%) underwent additional stenting. During intervention, the two groups did not differ significantly. After the intervention, the need for auxiliary opioids was higher (12.5% vs 7.7%; p = 0.571) and nausea/vomiting was more frequently observed (33.4% vs 3.8%; p = 0.007) in patients with remifentanil than in patients with PSA. Overall, 45 patients (90.0%) needed additional administration of non-opioid analgesics during postinterventional observation. Remifentanil and combined midazolam, piritramide, and S-ketamine obtained adequate analgesic effects during PTBD. After the intervention, medications with antiemetics and long-acting analgesics were more frequently administered in patients treated with remifentanil (EudraCT No. 2006-003285-34; institutional funding).https://doi.org/10.1515/med-2020-0220biliary tractcholestasisprocedural sedationanalgesiainterventional radiologyremifentanilpiritramidemidazolams-ketamine |
| spellingShingle | Zanvettor Alex Lederer Wolfgang Glodny Bernhard Chemelli Andreas P. Wiedermann Franz J. Procedural sedation and analgesia for percutaneous trans-hepatic biliary drainage: Randomized clinical trial for comparison of two different concepts Open Medicine biliary tract cholestasis procedural sedation analgesia interventional radiology remifentanil piritramide midazolam s-ketamine |
| title | Procedural sedation and analgesia for percutaneous trans-hepatic biliary drainage: Randomized clinical trial for comparison of two different concepts |
| title_full | Procedural sedation and analgesia for percutaneous trans-hepatic biliary drainage: Randomized clinical trial for comparison of two different concepts |
| title_fullStr | Procedural sedation and analgesia for percutaneous trans-hepatic biliary drainage: Randomized clinical trial for comparison of two different concepts |
| title_full_unstemmed | Procedural sedation and analgesia for percutaneous trans-hepatic biliary drainage: Randomized clinical trial for comparison of two different concepts |
| title_short | Procedural sedation and analgesia for percutaneous trans-hepatic biliary drainage: Randomized clinical trial for comparison of two different concepts |
| title_sort | procedural sedation and analgesia for percutaneous trans hepatic biliary drainage randomized clinical trial for comparison of two different concepts |
| topic | biliary tract cholestasis procedural sedation analgesia interventional radiology remifentanil piritramide midazolam s-ketamine |
| url | https://doi.org/10.1515/med-2020-0220 |
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