Objective. We aimed to study the differences in perception of pain during cardiac catheterization with midazolam monotherapy compared to the current standard of midazolam plus fentanyl. Background. Procedural sedation is important to ensure comfort and safety in patients undergoing left heart catheterization. Despite the widespread use of midazolam and fentanyl for procedural sedation, the effectiveness of this dual agent approach to sedation has never been studied in comparison to midazolam monotherapy. Methods. A total of 129 patients undergoing sedation for outpatient elective cardiac catheterization were randomly assigned to either midazolam monotherapy (n = 69) or combination of midazolam and fentanyl (n = 60). The primary outcome was assessment of pain perception prior to discharge by patient completion of a pain questionnaire. Participants were asked if they experienced any pain during their procedure (yes/no) and, if yes, asked to rate their overall pain level using a 10-point Likert scale that ranged from 1 (minimal pain) to 10 (worst pain imaginable). Results. Most patients (n = 94, 73%) reported no pain during their procedure. Patients sedated with midazolam monotherapy reported similar average pain scores compared to patients sedated with the combination of midazolam and fentanyl (1.1 vs. 1.1, ). Conclusions. Among patients undergoing elective cardiac catheterization, no significant differences in pain scores were noted between sedation with midazolam alone compared to midazolam and fentanyl. Due to fentanyl’s unfavorable interaction with P2Y12 agents, increased costs, and addiction potential, it is imperative that cardiologists revisit the role of effective procedural sedation with a single agent and avoid the use of fentanyl.

中文翻译：

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老是（不是）黄金：咪达唑仑单药治疗与咪达唑仑加芬太尼在心导管插入术中的镇静作用

客观。我们的目的是研究与咪达唑仑加芬太尼的现行标准相比，咪达唑仑单药治疗心导管术期间疼痛感知的差异。背景。程序性镇静对于确保接受左心导管插入术的患者的舒适性和安全性很重要。尽管咪达唑仑和芬太尼广泛用于程序镇静，但与咪达唑仑单药治疗相比，从未研究过这种双重镇静方法的有效性。方法。共有 129 名因门诊择期心导管术而接受镇静的患者被随机分配接受咪达唑仑单药治疗（n  = 69）或咪达唑仑和芬太尼联合治疗（ n = 60)。主要结果是通过患者完成疼痛问卷在出院前评估疼痛感知。参与者被问及他们在手术过程中是否经历过任何疼痛（是/否），如果是，则要求他们使用从 1（最小疼痛）到 10（可想象的最严重疼痛）的 10 点李克特量表评估他们的整体疼痛程度. 结果。大多数患者 ( n  = 94, 73%) 报告在他们的手术过程中没有疼痛。与使用咪达唑仑和芬太尼联合镇静的患者相比，使用咪达唑仑单药镇静的患者报告的平均疼痛评分相似（1.1 vs. 1.1，）。 结论。在接受选择性心导管插入术的患者中，与咪达唑仑和芬太尼相比，单独使用咪达唑仑镇静的疼痛评分没有显着差异。由于芬太尼与 P2Y12 药物的不利相互作用、增加的成本和潜在的成瘾性，心脏病专家必须重新审视使​​用单一药物进行有效程序镇静的作用并避免使用芬太尼。