Post written by Salman Nusrat, MD, from the University of Oklahoma Health Sciences Center and the Veterans Affairs Medical Center, Oklahoma City, Oklahoma, USA.

The primary aim of our study was to evaluate if the addition of diphenhydramine to routinely used sedatives will decrease the amount of fentanyl and midazolam used during colonoscopy in patients on chronic opioid therapy.

Adequate sedation is important for safe and successful completion of colonoscopy. Chronic opioid use results in tolerance to routinely used sedatives. Over the last few decades we have seen a dramatic increase in the use of opioids in the general population. As a result, a large number of endoscopic procedures are performed on patients on chronic opioid therapy. Use of deeper sedation is associated with higher cost, and the role of adjunct sedatives remains controversial. We aimed to determine if the addition of diphenhydramine to standard sedative will improve objective and subjective measures of procedural sedation.

Our results show that in patients on chronic opioid therapy administration of diphenhydramine as an adjunct to conventional sedatives does not allow for lower doses of fentanyl and midazolam but improves quality of sedation without increasing the number of adverse events. Studies to further evaluate the optimal use of diphenhydramine in a difficult-to-sedate population are needed.

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