Abstract
BackgroundEndoscopic retrograde cholangiopancreatography (ERCP) has been increasingly used to treat patients with biliary/pancreatic duct obstruction or stricture outside the operating room. Effective and safe sedation techniques are needed because of painful stimuli and the long duration of the ERCP procedure.Nalbuphine has been shown to cause less respiratory depression during sedation than similar cases without nalbuphine. This study compared the effects of propofol-nalbuphine (PN) and propofol-fentanyl (PF) sedation in patients undergoing ERCP.MethodsFour hundred patients scheduled for ERCP procedures were divided into two groups: the PF group (receiving PF sedation,n = 199) and the PN group (receiving PN sedation,n = 201). Vital signs, adverse events during surgery, patient movement scores, pain scores, and adverse events one day post-ERCP were recorded.ResultsStable haemodynamics were observed in both groups.Compared to the PF group, the PN group showed significantly decreased respiratory depression (P < 0.0001) and surgical interruptions (P = 0.048).Nalbuphine decreased patient movement by reducing pain from ERCP.ConclusionNalbuphine, instead of fentanyl, precipitated less respiratory depression while permitting adequate/equivalent sedation for ERCP and therefore provides more efficient and safer sedation.Trial registrationChiCTR, ChiCTR1800016018, Registered 7 May 2018, http://www.chictr.org.cn/showproj.aspx?proj=27085
Highlights
Endoscopic retrograde cholangiopancreatography (ERCP) has been increasingly used to treat patients with biliary/pancreatic duct obstruction or stricture outside the operating room
This study recruited 400 patients scheduled for ERCP from May 2018 to June 2019 at our centre.The patients were randomized to two groups.The PN group included 201 patients, and the PF group had 199 patients
There were no significant differences in the haemodynamic features of the patients (HR, MAP, respiratory rate (RR), and Oxygen saturation (SpO2)) between the two groups(p > 0.05), the PF group showed greater fluctuation than the PN group did in Heart rate (HR), MAP and SpO2
Summary
Endoscopic retrograde cholangiopancreatography (ERCP) has been increasingly used to treat patients with biliary/pancreatic duct obstruction or stricture outside the operating room. Effective and safe sedation techniques are needed because of painful stimuli and the long duration of the ERCP procedure.Nalbuphine has been shown to cause less respiratory depression during sedation than similar cases without nalbuphine. Compared to the administration of propofol alone,the application of propofol with fentanyl for ERCP can reduce the total dose of propofol, decrease the pain level, increase practitioner satisfaction, and provide haemodynamic stability but is more likely to induce respiratory depression, muscle stiffness and airway obstruction [11, 12]
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