A Randomized control study of audio versus visual distraction to reduce patient discomfort during colonoscopy

Abstract

INTRODUCTION : Colonoscopy can cause anxiety and discomfort in patients who undergo this procedure. Heavy sedation and analgesia as premedication can lead to complications in the elderly and those with co-morbidities. This has led to an interest in use of audio-visual distraction during the colonoscopy as an adjunct. Our aim was to compare effects of audio (AD) versus visual distraction (VD) in reducing discomfort and need for sedation during colonoscopy. METHODS : Consecutive consenting patients who were undergoing colonoscopy were randomized into three groups: one group was allowed to listen to the music of their choice (AD), the second group was allowed to watch a film of their choice (VD) (using SONY head mounted display:HMZ-T3W-H) and the third group with neither during colonoscopy acted as a control (C). Patient controlled sedation (PCS) was administered to all three groups. We used 25 mg pethidine in 5 mg aliquots and 2.5 mg midazolam in 0.5 mg aliquots. All patients were assessed for pain, number of ‘top-ups’ of sedation, total dose of pethidine and midazolam, patient cooperation and willingness to repeat the procedure. RESULTS :There were 77 patients [AD, n=25 (16 males, median age 57 years); VD, n=26, (18 males, median age 58 years); C, n=26 (10 males, median age 59 years)]. The AD group had significantly less pain (p=0.048), number of ‘top-ups’ of sedation (p=0.03), total doses of pethidine (p=0.03) and midazolam (p=0.032), and better patient cooperation (p=0.001) compared with controls. There was no difference between the AD (72%) and VD (73%) groups in willingness to undergo a repeat procedure. Conclusions AD reduces pain and discomfort and the requirement for sedation and seems a useful and simple adjunct to low dose sedation use during colonoscopy.