Efficacy and safety of remifentanil and fentanyl in adult endoscopic interventions: a systematic review and meta-analysis of randomized controlled trials

Authors:

Наталья Александровна Барковская,

Ефим Муневич Шифман,

Денис Николаевич Проценко,

Александр Валентинович Боярков

Журнал: Анестезиология и реаниматология. 2026;(4):73-89.

DOI: 10.17116/anaesthesiology202604173

Read: 2021 раз

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Abstract

Despite the growing interest in remifentanil for endoscopic procedures, available data are conflicting.

OBJECTIVE

To evaluate efficacy and safety of remifentanil and fentanyl for analgesia in adults undergoing endoscopic procedures.

MATERIAL AND METHODS

Nine biomedical databases were screened regarding randomized controlled trials (RCTs) involving remifentanil or fentanyl as components of analgesia for endoscopic procedures under spontaneous breathing in adults. Primary endpoints included procedural measures (time to induction, recovery and complete recovery, achievement of discharge criteria), incidence of intraoperative respiratory depression and postoperative pain. The review was conducted in accordance with the PRISMA 2020 guidelines.

RESULTS

Meta-analysis included 16 RCTs (1.242 patients). Remifentanil provided faster induction (MD –1.47 min, 95% CI –2.27 to –0.68, p=0.0003) and awakening (MD –2.98 min, 95% CI –4.25 to –1.72, p<0.00001) compared to fentanyl. Remifentanil provided earlier complete recovery (MD –5.64 min, 95% CI –7.67 to –3.61, p<0.00001) and complete recovery for discharge (MD –22.24 min, 95% CI –26.91 to –17.57, p<0.00001). Remifentanil was associated with a trend towards higher risk of respiratory depression compared to fentanyl, but the difference was insignificant (RR=1.25; 95% CI 0.89 to 1.75; p=0.19). Both opioids had equivalent profiles in terms of blood pressure control, bradycardia risk, and postoperative pain.

CONCLUSION

Remifentanil significantly reduces time to induction, recovery and complete recovery, as well as achievement of discharge criteria in endoscopic procedures in adults. However, these results are preliminary due to low certainty of evidence (GRADE ⊕⊕◯◯). When using remifentanil, strict monitoring of gas exchange and readiness for mechanical ventilation are necessary. Further randomized controlled trials are needed to determine optimal dose of remifentanil, especially in high-risk patients.

Keywords

remifentanil
fentanyl
analgesia
bronchoscopy
colonoscopy
gastrointestinal endoscopy
cholangio-pancreatography

Участие авторов

Study concept and design — E.M. Shifman, N.A. Barkovskaya

Data collection and processing — N.A. Barkovskaya, E.M. Shifman, A.V. Boyarkov

Statistical data analysis — N.A. Barkovskaya

Writing — N.A. Barkovskaya

Editing — E.M. Shifman, D.N. Protsenko

Конфликт интересов

N.A. Barkovskaya received honoraria for lectures from the Moscow Endocrine Plant (Endopharm), Russia; E.M. Shifman is a member of the scientific advisory board of Endopharm; D.N. Protsenko has no conflict of interest; A.V. Boyarkov received honoraria for lectures from Endopharm. The sponsor did not participate in the study design, protocol development, data collection, data analysis, or writing of the article.

Дата поступления: 01.03.2026

Дата принятия в печать: 15.04.2026

Дата публикации: 24.08.2026

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