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Cardiology Research and Practice
Volume 2018, Article ID 2363062, 5 pages
https://doi.org/10.1155/2018/2363062
Research Article

Painful Recall in Elective Electrical Cardioversion with Propofol and the Need for Additional Analgesia

1Department of Emergency Medicine, Reinier de Graaf Hospital, Delft, Netherlands
2Department of Intensive Care, Haaglanden Medical Center, The Hague, Netherlands
3Department of Cardiology, Reinier de Graaf Hospital, Delft, Netherlands
4Department of Anaesthesiology, Reinier de Graaf Hospital, Delft, Netherlands

Correspondence should be addressed to A. Westra; ln.ggdr@artsew.a

Received 20 January 2018; Revised 3 May 2018; Accepted 24 June 2018; Published 22 July 2018

Academic Editor: Terrence D. Ruddy

Copyright © 2018 D. F. M. van Winden et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.