Abstract
Introduction Electrical cardioversion (ECV) is a short but painful procedure for treating cardiac dysrhythmias. There is a wide variation regarding the medication strategy to facilitate this procedure. Many different sedative techniques for ECV are described. Currently, the optimal medication strategy to prevent pain in ECV has yet to be established. The role for additional analgesic agents to prevent pain during the procedure remains controversial, and evidence is limited. Methods We conducted a prospective multicenter study to determine the incidence of painful recall in ECV with propofol as a sole agent for sedation, in order to assess the indication for additional opioids. In all patients, sedation was induced with propofol titrated till loss of eyelash reflex and nonresponsiveness to stimuli, corresponding to Ramsay Sedation Score level 5-6. ECV was performed with extracardiac biphasic electrical shocks. The primary outcome was painful recall of the procedure, defined as numeric pain rating scale (NRS) ≥ 1. NRS ≥ 4 is considered inadequately treated pain. Secondary outcome parameters were pain at the side of the defipads and muscle pain after ECV. Results A total of 232 patients were enrolled in this study. Six patients were excluded due to missing data or violation of study protocol. Three patients reported recall of the procedure, and one patient (0.4%) reported recall of severe pain during the procedure with NRS 7. Two patients (0.9%) reported recall of mild pain with NRS 1–3. Complete amnesia was observed in 223 patients (98.7%), with NRS 0. The mean of the total dose of propofol was 1.1 mg/kg. Fifteen patients (6.6%) experienced pain at the side of the defipads, and six patients (2.7%) complained of muscle pain after the procedure. Conclusions In this prospective multicenter study, propofol as a sole agent provided good conditions for ECV with a low incidence of recall. Effective sedation and complete amnesia was achieved in 98.7% of the patients, 0.4% of patients reported recall of severe pain during the procedure, and 0.9% of patients experienced mild pain during the ECV.
Highlights
Electrical cardioversion (ECV) is a short but painful procedure for treating cardiac dysrhythmias. ere is a wide variation regarding the medication strategy to facilitate this procedure
Incidences varied from 0 to 23% [2,3,4,5,6,7,8,9,10,11,12,13,14]. ese studies had several limitations: recall was not the primary outcome measure, findings were based on small patient groups, results were not differentiated for the sedatives used, supplemental opioids were given, and the studies described a variety of short painful procedures or did not reflect clinical practice
The optimal medication strategy to prevent pain in ECV has yet to be established. e evidence for the use of analgesic agents such as opioids in conjunction with sedatives to prevent pain is limited and controversial. e aim of this study was to determine the incidence of painful recall in ECV using propofol as the sole agent for sedation and to assess the need for additional analgesia
Summary
Electrical cardioversion (ECV) is a short but painful procedure for treating cardiac dysrhythmias. ere is a wide variation regarding the medication strategy to facilitate this procedure. We conducted a prospective multicenter study to determine the incidence of painful recall in ECV with propofol as a sole agent for sedation, in order to assess the indication for additional opioids. In this prospective multicenter study, propofol as a sole agent provided good conditions for ECV with a low incidence of recall. Effective sedation and complete amnesia was achieved in 98.7% of the patients, 0.4% of patients reported recall of severe pain during the procedure, and 0.9% of patients experienced mild pain during the ECV. Ese studies had several limitations: recall was not the primary outcome measure, findings were based on small patient groups, results were not differentiated for the sedatives used, supplemental opioids were given, and the studies described a variety of short painful procedures or did not reflect clinical practice Incidences varied from 0 to 23% [2,3,4,5,6,7,8,9,10,11,12,13,14]. ese studies had several limitations: recall was not the primary outcome measure, findings were based on small patient groups, results were not differentiated for the sedatives used, supplemental opioids were given, and the studies described a variety of short painful procedures or did not reflect clinical practice
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