Limited analgesic efficacy of nitrous oxide for painful procedures in children

Abstract

Study objective: Nitrous oxide (N 2 O) is an attractive agent for procedural analgesia and sedation of children in the emergency department (ED). Despite increasing use, efficacy data for painful procedures are limited. This study aimed to determine pain scores during ED procedural sedation with N 2 O in the ED setting. Methods: Prospective observational study of N 2 O use as a sole agent for procedural analgesia at a tertiary children's hospital ED. Pain scores were obtained from patients and parents using visual analogue or faces scales, as appropriate. Parent and staff satisfaction with sedation and analgesia were assessed. Results: 124 children aged 1-17 years (mean 8.1) underwent procedural analgesia with N 2 O for 131 procedures. Most procedures were orthopaedic (44%) or laceration repair (30%). In 51% of patients (95% CI 42% to 60 to 23%) pain scores remained unchanged and in 34% (95% CI 26% to 43%) pain scores increased. Overall, 34% (95% CI 26% to 43%) patients had intraprocedural scores of 50 mm or greater and 21% (95% CI 14% to 29%) had pain scores of 70 mm or greater. Some procedures such as fracture reduction had a larger proportion of patients with high pain scores or 50 mm or greater (45%) and 70 mm or greater (29%). Staff rated both sedation and analgesia as ''adequate'' in 92%. Parents contacted in follow-up were satisfied or very satisfied with procedures in 96% and sedations in 93%. Conclusion: Data indicate that parents and staff are generally satisfied with N 2 O for procedural use in the ED. The efficacy of N 2 O as a sole agent in very painful procedures is limited.

Entonox Efficacy for Procedural-Sedation and Analgesia in Pediatrics Undergoing Bone Marrow Aspiration: A Randomized Clinical Trial

“…In contrast with the present study, despite acknowledging the high rate of satisfaction among the children's families, Babl et al, deemed the efficacy of this gas unsuitable for solo use during the highly painful procedures such as orthopedic procedures (20). However, it should be noted that Babl et al, only used entonox for PSA, while in the present study it was used as an adjuvant.…”

Management of Pain in the Emergency Department

“…So why is the agent used with relative infrequency? The reasons are probably related to its efficacy-which is good but not 100% [158][159][160] and thus may prompt need for a coadministered agent-as well as the requirement for specialized training and equipment (for both delivery and "scrubbing" to clear this potentially teratogenic gas from the healthcare setting) [161][162][163].…”

Schmerzkonzept einer kinderchirurgischen Klinik

“…Die therapeutische Breite des Lachgases ist sehr groß [3,8,17], sollte jedoch nicht überstrapaziert werden. Hennrikus et al [12] publizierten eine signifikant erhöhte Rate von Therapieversagern bei der geschlossenen Reposition komplett dislozierter Unterarmfrakturen.…”

“…Babl et al [3] berichteten über eine Rate von 2,4%. Die im eigenen Kollektiv gering höhere Rate von 2% Therapieversagern ist v. a. mit der bei einem Patienten falsch gestellten Indikation der Lachgasapplikation zu erklären.…”

“…Die Möglichkeit der inhalativen Behandlung mit Lachgas sowohl unter Elektiv-als auch unter Notfallbedingungen war bisher keinem der 149 (100%) Elternpaare bekannt. [3] 2008 in Australien.…”