Association of Self-Administered Nitrous Oxide for Labor Analgesia With Maternal and Neonatal Process and Outcome Measures

Hoffman, Sandra; Sidebottom, Abbey; Wrede, Jane; Kreiger, Robert; Watkins, Alison; Taghon, Jessica

doi:10.1016/j.jogn.2020.11.002

“…In discussing with the patients about possible disadvantages of pain relief with Entonox, we should present the increased risk of episiotomy in multiparas -for some patients it may be an important argument for or against the use of Entonox. We found no literature regarding perineal trauma in correlation to the nitrous oxide use during labor, but study assessing maternal outcome revealed no influence of this type of pain relief on the analyzed measures [27].…”

Section: Discussionmentioning

confidence: 74%

Influence of Entonox (mixture of 50% nitrous oxide and 50% oxygen) on physiological labor and neonatal outcome in own material

Minowski¹,

Swiatkowska‐Freund

²

,

Preis

³

2023

Ginekol Pol

0

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“…Our findings of overall low and comparable rates of short-term adverse neonatal outcomes after exposure to intrapartum nitrous oxide are consistent with prior literature on neonatal outcomes. 11,13,18 Although our study did not evaluate the duration of nitrous oxide use, the overall short duration of nitrous oxide use intrapartum and its short half-life may explain the lack of observed neonatal toxicity. 4,19 Nitrous oxide rapidly enters alveoli when inhaled, but it is also eliminated quickly by the lungs 20 and, therefore, is not thought to accumulate in the pregnant patient or fetus or neonate.…”

Section: Discussionmentioning

confidence: 93%

“…Prior studies support our findings that nulliparous patients are more likely to try nitrous oxide for labor analgesia. [11][12][13][14] This may be because nitrous oxide is a newer mode of labor analgesia in the United States, 15 and patients with prior labor experience may be less likely to choose a new modality.…”

Section: Discussionmentioning

confidence: 99%

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Association Between Intrapartum Nitrous Oxide for Labor Analgesia and Short-Term Neonatal Outcomes

Starosta,

Lundsberg,

Culhane

et al. 2024

Obstetrics &Amp; Gynecology

2

0

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OBJECTIVE: To evaluate the association between intrapartum nitrous oxide use and adverse short-term neonatal outcomes. METHODS: This was a retrospective cohort study of individuals with singleton gestations at 35 or more weeks who attempted labor and delivered at an academic hospital between June 1, 2015, and February 28, 2020. Data were extracted from the electronic medical record using billing and diagnostic codes. Patients were classified based on whether they received no intrapartum analgesia or received nitrous oxide only. Those who received other analgesia types were excluded. The primary outcome was neonatal intensive care unit (NICU) admission. Secondary outcomes included Apgar score less than 7 at 1 minute and 5 minutes, respiratory composite outcome (including meconium aspiration syndrome, neonatal bronchopulmonary disorders, neonatal transient tachypnea, and other neonatal respiratory distress that required NICU admission), hypoglycemia, and hyperbilirubinemia. Univariable and multivariable analyses were used to estimate the association between nitrous oxide exposure intrapartum and the selected outcomes. RESULTS: Of 6,047 included, 4,153 (68.7%) received no analgesia, and 1,894 (31.3%) received nitrous oxide only. In comparison with individuals who received no analgesia, those who received nitrous oxide were more likely to be nulliparous, be of Black racial identity, have noncommercial insurance, and be less likely to deliver by intrapartum cesarean. The reception of nitrous oxide, compared with the reception of no analgesia, was associated with a lower likelihood of NICU admission (6.4% vs 8.1%; adjusted odds ratio [aOR] 0.77, 95% CI, 0.62–0.96) and an increased likelihood of neonatal hyperbilirubinemia (aOR 1.23, 95% CI, 1.08–1.41). Inhaled nitrous oxide exposure, in comparison with the reception of no analgesia, was not associated with the other secondary outcomes, including Apgar score less than 7 at 1 minute (odds ratio [OR] 0.74, 95% CI, 0.50–1.10) or 5 minutes (OR 0.91, 95% CI, 0.32–2.60), respiratory composite outcome (OR 0.91, 95% CI, 0.70–1.17), and hypoglycemia (OR 0.82, 95% CI, 0.64–1.05). CONCLUSION: In this single-center retrospective cohort of low-risk patients, intrapartum inhaled nitrous oxide, compared with the reception of no analgesia, was associated with a decreased risk for NICU admission but with an increased risk for hyperbilirubinemia; other outcomes did not differ. These findings may be used to counsel patients when considering nitrous oxide for labor analgesia.

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“…Bupivacaine can enhance the permeability of fat-soluble membranes, and the effect of ropivacaine is relatively mild, so the toxicity of bupivacaine is stronger [ 12 ]. Animal model experiments show that the distribution of local anesthesia was different between intrathecal and epidural anesthesia, and the bioavailability of intrathecal ropivacaine decreased after epidural injection [ 13 ]. There exhibits no significant difference in sensory block between opium and Bubby.…”

Section: Introductionmentioning

confidence: 99%

Analgesic Effects, Birth Process, and Prognosis of Pregnant Women in Normal Labor by Epidural Analgesia Using Sufentanil in Combination with Ropivacaine: A Retrospective Cohort Study

Mao

¹

,

Zhang

²

,

Zhu

³

2022

Computational Intelligence and Neuroscience

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Objective. The objective is to evaluate the analgesic, labor, and prognostic effects of patient-controlled epidural analgesia (PCEA) versus sufentanil in conjunction with ropivacaine in normal labor. Methods. Sixty pregnant women who had a normal delivery at our hospital between February 2019 and April 2021 were included. Pregnant women were arbitrarily assigned to a control group and a research group. Pregnant women in the control group received lidocaine analgesia and PCEA with sufentanil combined with ropivacaine in the research group. Satisfaction with care, fetal umbilical artery blood flow, VAS score, labor and bleeding, neonatal Apgar score and incidence of adverse events were analyzed. Results. First, we made a comparison of satisfactory performance of nursing care. The satisfaction rate of the research group was 100.00%, compared to 83.33% for the control group. Nursing satisfaction was higher in the research group, and the difference was statistically significant ( P < 0.05 ). Following analgesia, PI, RI, and S/D values of umbilical artery blood flow were lower in the research group than those in the control group, but the difference was not statistically significant ( P > 0.05 ). The VAS scores at 10 min, 20 min, and 30 min were found to be lower in the research group than in the control group after analgesia, and the difference was statistically significant ( P < 0.05 ). Bleeding was significantly lower in the research group for all stages of labor, and the difference was statistically significant ( P < 0.05 ). Apgar scores at 1 minute, 5 minutes, and 10 minutes postpartum were greater in the research group than in the control group, and the difference was statistically significant ( P < 0.05 ). As a final note, the incidence of pruritus, hypotension, respiratory depression, nausea, and vomiting was found to be lower in the research group than in the control group, and the difference was statistically significant ( P < 0.05 ). Conclusion. PCEA with sufentanil coupled with ropivacaine was used to perform labor analgesia. With significant reduction in maternal pain and assurance of labor, ropivacaine combined with sufentanil epidural labor analgesia did not reduce fetal umbilical artery blood flow without extended labor. It could not affect the labor process or the safety of the fetus, which is safe for the mother and fetus.

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Association of Self-Administered Nitrous Oxide for Labor Analgesia With Maternal and Neonatal Process and Outcome Measures

Cited by 5 publications

References 27 publications

Influence of Entonox (mixture of 50% nitrous oxide and 50% oxygen) on physiological labor and neonatal outcome in own material

Influence of Entonox (mixture of 50% nitrous oxide and 50% oxygen) on physiological labor and neonatal outcome in own material

Association Between Intrapartum Nitrous Oxide for Labor Analgesia and Short-Term Neonatal Outcomes

Analgesic Effects, Birth Process, and Prognosis of Pregnant Women in Normal Labor by Epidural Analgesia Using Sufentanil in Combination with Ropivacaine: A Retrospective Cohort Study

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