Aboumarzouk Omar M, Agarwal Trisha, Syed Nong Chek Syed Aidil Hizman, Milewski Peter J, Nelson Richard L
Department of Urology, Academic Clinical practice, Division of Clinical and Population Sciences, University of Dundee, Dundee, Scotland, UK, DD1 9SY.
Cochrane Database Syst Rev. 2011 Aug 10(8):CD008506. doi: 10.1002/14651858.CD008506.pub2.
Colonoscopy is the gold standard investigation for large bowel disease. With the increase in demand, pressure is on clinics to shorten lengths of time per procedure in addition to maintaining high levels of patient safety. Analgesia has always been the mainstay of adequate pain relief, but it leads to prolonged recovery and lengths of hospital stay, in addition to increased risk of cardio-respiratory side effects. N2O/O2 mixtures have been used for its effective analgesic effect and short half life and provides an alternative method of sedation for colonoscopy procedures.
The primary objective was to compare the overall effectiveness of nitrous oxide mixtures to other types of pain relief used during colonoscopy procedures to provide adequate pain/discomfort relief.The secondary objective was to compare between nitrous oxide and other types of pain relief with respect to hospitalisation/recovery time, side effects, patients and endoscopists satisfaction, and colonoscopy completion rates.
The following electronic databases were searched: Cochrane Central Register of Controlled Trials (CENTRAL) on The Cochrane Library, MEDLINE (1966- present), EMBASE (1980 - present), and the Internet (Google Scholar).
Randomised controlled trials which compared nitrous oxide to placebo or active comparators for patients undergoing elective colonoscopic procedures. Patients with known underlying causes of pain/discomfort were excluded.
Seven randomised trials were included. Each trial compared a nitrous oxide/oxygen mixture to a placebo or sedation +- other analgesic drugs on patients undergoing elective colonoscopic procedures. The results of these studies were analysed and discussed.
There were a total of 547 patients included.There were 257 patients randomised to receive the N2O/O2 mixture (7 studies), while 225 patients received some form of sedation with or without other analgesia (6 studies), and 65 patients received a placebo (3 studies).Four studies showed that N2O/O2 is as good in controlling pain/discomfort as conventional methods, while one showed sedation was better and another study showed N2O/O2 was better.Six of the studies showed that N2O/O2 groups had quicker recovery times and shorter lengths of hospital stays while one study showed that there was no difference between the two groups.Two studies showed that N2O/O2 was safer while one reported that sedation was safer.
AUTHORS' CONCLUSIONS: Nitrous oxide is as efficient and safer than various pain relief methods used during colonoscopy procedures, but further trials are necessary.
结肠镜检查是大肠疾病的金标准检查方法。随着需求的增加，诊所面临着在保持高水平患者安全的同时缩短每次检查时间的压力。镇痛一直是充分缓解疼痛的主要手段，但它会导致恢复时间延长和住院时间延长，此外还会增加心肺副作用的风险。一氧化二氮/氧气混合物因其有效的镇痛作用和较短的半衰期而被用于结肠镜检查的镇静替代方法。
主要目的是比较一氧化二氮混合物与结肠镜检查过程中使用的其他类型镇痛方法的总体有效性，以提供充分的疼痛/不适缓解。次要目的是比较一氧化二氮与其他类型镇痛方法在住院/恢复时间、副作用、患者和内镜医师满意度以及结肠镜检查完成率方面的差异。
检索了以下电子数据库：Cochrane图书馆中的Cochrane对照试验中心注册库（CENTRAL）、MEDLINE（1966年至今）、EMBASE（1980年至今）以及互联网（谷歌学术）。
将一氧化二氮与安慰剂或活性对照剂用于择期结肠镜检查患者的随机对照试验。已知有疼痛/不适潜在原因的患者被排除。
纳入了七项随机试验。每项试验将一氧化二氮/氧气混合物与安慰剂或镇静剂±其他镇痛药物用于择期结肠镜检查患者进行比较。对这些研究的结果进行了分析和讨论。
共纳入547例患者。257例患者随机接受一氧化二氮/氧气混合物（7项研究），225例患者接受某种形式的镇静，有无其他镇痛药物（6项研究），65例患者接受安慰剂（三项研究）。四项研究表明一氧化二氮/氧气在控制疼痛/不适方面与传统方法一样好，一项研究表明镇静更好，另一项研究表明一氧化二氮/氧气更好。六项研究表明一氧化二氮/氧气组恢复时间更快，住院时间更短，而一项研究表明两组之间没有差异。两项研究表明一氧化二氮/氧气更安全，一项研究报告镇静更安全。
一氧化二氮在结肠镜检查过程中比各种镇痛方法更有效、更安全，但仍需进一步试验。
