Unsedation colonoscopy can be not that painful: Evaluation of the effect of “Lamaze method of colonoscopy”

Table 1 Lamaze method of childbirth and the Lamaze method of colonoscopy

Lamaze method of childbirth[8,9]	Thoracic breathing: Used in initial stage of uterus contraction, method: (1) completely relaxed; (2) eyes fixed on a certain point; (3) abdominal stay relaxed while breath in from nose, breath out from mouth; (4) a total of 6-9 times of inspiration and expiration per minute; and (5) practice 5 times a day, 60 s each time
	Shallow and slow accelerating breathing: Use when the uterus contracts each 2-4 min, cervix opened to 2-8 cm. Method: Step (1-3) is the same with thoracic breathing; and (4) accelerate the breathing when uterus contraction enhanced, slow it down while contraction relieves
	Shallow breathing: Use when the uterus contracts lasts for 60-90 s each 30-90 s , cervix opens to 8-10 cm Method: Step (1-2) is the same with thoracic breathing; (3) open mouth slightly to help breath (making a sound "hee-hee"); (4) breathing with nose, making noise from the larynx; (5) adjust the respiratory rate according to intensity of the contraction; (6) inspiration and expiration the same volume of air to avoid hyperventilation; and (7) 4-6 quickly continue inspiration and expiration then vigorously exhale, repeat until uterus contraction stops
	Close air-way and force movement: Used when cervix is full opened to 10 cm. Method: (1) legs apart, hands holding handrail of obstetric delivery bed; (2) vigorously aspirated and close air-way, force down; (3) head up slightly staring at navel with jaw neck down forward; and (4) hold breath for 20-30 s as far as possible, exhale and hold breath at once and force movement until uterus contraction stops
	Halitus movement: Used when cannot exert herself but cannot help to do it. Method: (1) mouth open, breathing quickly like gasping; and (2) the whole body is relaxed totally
The Lamaze method of colonoscopy	Thoracic breathing: Used when the procedure begins, method: (1) completely relaxed; (2) eyes fixed on a certain point; (3) abdominal stay relaxed while breath in from nose, breath out from mouth; and (4) a total of 6-9 times of inspiration and expiration per minute
	Shallow and slow accelerating breathing: Used when the scope is crossing the junction of sigmoid colon and descending colon from the sigmoid colon. Method: Step (1-3) is the same with thoracic breathing; and (4) accelerate the breathing when pain enhanced, slow it down while pain relieved
	Shallow breathing: Used when the scope is crossing the splenic flexure. Method: (1) completely relaxed; (2) eyes fixed on a certain point; (3) open mouth slightly to help breath (making a sound "hee-hee"); (4) breathing with nose, making noise from the larynx; (5) adjust the respiratory rate according to pain intensity; (6) inspirate and expirate the same volume of air to avoid hyperventilation; and (7) 4-6 quick continue inspirate and expirate then vigorously exhale, repeat until the pain disappear
	Close air-way and force movement: Used when the pain is moderate or severe. Method: (1) vigorously aspirated and close air-way, force down; and (2) hold breath for 20-30 s as far as possible, exhale and hold breath at once and force movement until pains relieves or disappeared

Table 2 Comparison on patients’ age, gender, previous colonoscopy history and previous abdominal surgery history

	Age (yr)	Gender (male/female)	Previous colonoscopy(Y/N)	Previous abdominal surgery(Y/N)
Lamaze group	54.9 ± 9.9	118/106	88/136	43/181
Anesthetic group	55.6 ± 9.7	76/102	62/116	25/153
Control group	56.3 ± 8.6	98/85	66/117	31/152
P	0.197	0.07	0.633	0.403

Table 3 Comparison on the quality of bowel cleanliness

	Grade 1	Grade 2	Grade 3
Lamaze group	168	36	20
Anesthetic group	123	38	17
Control group	137	29	17

χ² = 2.657; P = 0.617.

Table 4 Comparison on intestinal lesions

	Normal	Colon polyps	Colonic diverticulum	IBD	Colon cancer
Lamaze group	127	69	11	8	9
Anesthetic group	107	46	9	9	7
Control group	115	39	8	12	9

χ² = 6.293; P = 0.614. IBD: Inflammatory bowel disease.

Table 5 Comparison on patients' pain grading

	0-2	2-4	4-6	6-8	8-10
Lamaze group	47	96	77	3	1
Anesthetic group	142	35	1	0	0
Control group	6	7	71	88	11

χ² = 506.579; P < 0.001.

Table 6 Further pair-wised comparison of patients’ pain grading

	χ2	P
Lamaze group vs control group	194.43	< 0.001
Lamaze group vs anesthetic group	150.92	< 0.001
Anesthetic group vs control group	310.68	< 0.001

Table 7 Comparison on intubation time

	Intubation time (min)
Lamaze group	9.21 ± 2.76
Anesthetic group	7.46 ± 2.93
Control group	9.45 ± 2.38

F = 29.696, P < 0.001

Table 8 Further pair-wised comparisons on intubation time

	Mean difference	Standard error	P	95%CI
				Lower bound	Upper bound
Lamaze group vs control group	-0.243	0.269	0.368	-0.77	0.29
Lamaze group vs anesthetic group	1.75	0.271	< 0.01	1.22	2.28
Anesthetic group vs control group	-1.993	0.285	< 0.01	-2.55	-1.43

Table 9 Comparison on the quality of bowel cleanliness

	Success(Y/N)
Lamaze group	217/7
Anesthetic group	177/1
Control group	171/12

χ² = 9.918, P = 0.06.

Table 10 Comparison on complications

	Total	Bleeding	Perforation	Cardiopulmonary complications	Normal
Lamaze group	224	2	0	1	221
Anesthetic group	178	9	0	7	162
Control group	183	3	0	1	179

χ² = 18.043; P = 0.001.