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Sedation and pain relief options

All endoscopic procedures can be associated with some discomfort.

We can use sedation and pain relief to make procedures as comfortable as possible.

The type of sedation and pain relief you can have, will depend on the type of procedure you are having.

You do not need to decide in advance of your procedure, however if you would like to have the conscious sedation you will need to meet the criteria.

If you have any questions or would like to discuss your options, please contact the pre-assessment team on 01752 438407. You can also ask the nurses or the endoscopist on the day of your procedure.

You will get sent a procedure letter and consent form which will explain your sedation and pain relief options. You can also read about your options below.

Entonox

Entonox is sometimes referred to as ‘laughing gas’ or ‘gas and air’.

Entonox works very quickly and its effects are felt almost immediately after inhalation, providing very good pain relief and relaxing effect without losing consciousness or control. Entonox can be used as an alternative to intravenous sedation and pain relief for endoscopic procedures which examine the bowel; such as colonoscopy and flexible sigmoidoscopy.

Entonox is self-administered via a mouthpiece; therefore, you are in full control of your own pain relief. You will remain entirely awake during the procedure so many people find this is a more convenient approach.  The gas and its effects wear off quickly.

When the endoscopist is ready to start your procedure, the nurse will instruct you to take six to eight breaths of Entonox before your procedure starts. This will give the Entonox time to take full effect and for you to feel comfortable using the gas. You will then breathe the Entonox throughout your procedure whenever you feel uncomfortable.

There are no serious risks and very few side effects from inhaling Entonox gas. Occasionally you may feel some light headedness, some tingling in the fingers and face and a little sickness or dizziness. This usually happens if you are breathing the gas in and out too quickly. The nurse will tell you to slow down your breathing and the side effects will stop.

You will be able to operate machinery and drive after being discharged from the unit and you will not need anyone to look after you at home if you choose Entonox as your only pain relief.

Throat spray

Throat spray is a local anaesthetic that numbs the back of your throat to minimise discomfort.  It is sprayed on the back of the throat during Gastroscopy procedure. Many patients choose throat spray for diagnostic gastroscopy.

Numbing the back of the throat helps the camera to be inserted into the food pipe (oesophagus).  Many patients say that the spray tastes like bananas. 

Throat spray will help to reduce a natural gag reflex that all patients will experience.  This sensation can be unsettling but staff will support you with breathing techniques.  Please note that this sensation will not completely go away with throat spray and/or midazolam.

The procedure will take the same amount of time whether you have throat spray, conscious sedation, or throat spray and conscious sedation. Following the procedure most patients who have only had throat spray can leave the department as soon as their procedure is finished. If you have conscious sedation, you will spend about 30-40 mins in recovery afterwards. Throat spray wears off approximately 30 minutes after application.

You will be able to operate machinery and drive after being discharged from the unit and you will not need anyone to look after you at home if you choose throat spray as your only pain relief.

Conscious sedation

To have a conscious sedation, you receive an injection of one, or a combination of drugs to relax and reduce discomfort. Commonly in Plymouth we use a drug called Midazolam (a sedative or relaxing drug). Sometimes this may be combined with a strong painkiller called Fentanyl.

You can request a conscious sedation if you are having a gastroscopy or a colonoscopy. There are risks associated with an IV sedative, as this can reduce the body’s natural breathing response, however nursing and medical staff will be assessing you at all times. You may require additional oxygen support via a soft sponge/tube into the nose.

IV Midazolam is administered via a cannula into your hand or arm.  A cannula is a small plastic tube inserted with a small needle into a vein.  A cannula can be a little uncomfortable and it can cause some bruising.  This usually heals after a few days.  The cannula is removed shortly after the procedure is completed.  If you would like to choose conscious sedation, and have had a history of needing an ultrasound for finding a vein in the past – please let the unit know in advance as this will need to be arranged prior to you attending for your procedure.

The endoscopist/nurse providing the sedation will discuss with you what is best on the day. These medications are designed to make you feel comfortable and relaxed but are not anaesthetics and it is not intended to put you to sleep.

Conscious sedation may provide a more comfortable procedure but you will need to recover in hospital until its affects have worn off (approximately 30-40 mins afterwards). 

You will also need to arrange to be collected from the unit, be accompanied home and have someone to stay with you for 24 hours.  You should not use public transport to return home and you are not permitted to operate machinery, drive a car for 24 hours after conscious sedation or sign any legally binding documents.