Nitrous oxide for analgesia in external cephalic version at term: prospective comparative study<sup>a</sup>

Burgos, Jorge; Cobos, Patricia; Osuna, Carmen; Centeno, María de Mar; Fernández-Llebrez, Luis; Astorquiza, Txanton Martinez; Melchor, Juan Carlos

doi:10.1515/jpm-2013-0046

Cited by 16 publications

(12 citation statements)

References 23 publications

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“…However, the ECV maneuvers of our study were only performed by a selected subset of obstetricians with a high level of skill in the procedure acquired over a 10‐year period, with more than 1500 ECV procedures carried out and very similar long‐term success rates (in the range of 45–55%). Our results are in agreement with those reported in a similar trial by another group and with our previous results .…”

Section: Discussionsupporting

confidence: 94%

“…Our literature search found only two published studies reporting results with the use of these analgesics in ECV (7,16). One randomized controlled trial (16) did not show any difference in the success rate of ECV between remifentanil with paracetamol vs. placebo with paracetamol, but the mean pain score was lower in the remifentanil group than the control group.…”

Section: Discussionmentioning

confidence: 93%

“…Our group has focused on the use of other non‐invasive analgesics in ECV with a better safety profile. We conducted a study on nitrous oxide, which has lower analgesic power than regional analgesia, finding it to be useful in reducing pain but also that it did not increase the success rate of ECV . Similarly, Sullivan et al compared intravenous fentanyl (an opioid with high analgesic potency administered non‐invasively) with regional analgesia and found no evidence of differences in the rate of success .…”

Section: Introductionmentioning

confidence: 98%

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Increased pain relief with remifentanil does not improve the success rate of external cephalic version: a randomized controlled trial

Burgos

Pijoán

Osuna

et al. 2016

Acta Obstet Gynecol Scand

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Section: Discussionsupporting

confidence: 94%

Section: Discussionmentioning

confidence: 93%

Section: Introductionmentioning

confidence: 98%

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Increased pain relief with remifentanil does not improve the success rate of external cephalic version: a randomized controlled trial

Burgos

Pijoán

Osuna

et al. 2016

Acta Obstet Gynecol Scand

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“…Moreover, another study has showed that the two factors affecting motivation to undergo ECV are pain, with intense pain‐reducing motivation (OR 0.11, 95% CI 0.05‐0.23), and success rate, which increases willingness when high (OR 3.42, 95% CI 2.04‐5.74) . After we drafted our initial protocol, a prospective study was published comparing N 2 O/O 2 use in ECV for 150 women (September 2009‐December 2010) with ECV with no analgesia for 150 others (January‐August 2009) . They reported similar success rates in both groups: 52.3% in the N 2 O/O 2 group and 52.7% in the control group ( P = 0.94), but found that the N 2 O/O 2 group ranked the pain during the maneuver lower (median = 6, rank: 4‐7) than the control group did (median = 7, rank: 5‐8) ( P < 0.01).…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of nitrous oxide in external cephalic version on success rate: A randomized controlled trial

Dochez

Esbelin²,

Misbert

et al. 2019

Acta Obstet Gynecol Scand

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Introduction Approximately 4% of singleton pregnancies at term are in breech presentation. External cephalic version (ECV) can reduce the risks of noncephalic birth and cesarean delivery, but this maneuver can be painful. Our aim was to analyze the effect of administering inhaled nitrous oxide for analgesia on the ECV success rate. Material and methods This prospective, randomized, single‐blind, controlled trial included women with singleton pregnancies in breech presentation at term who were referred for ECV in a tertiary care center. Women were assigned according to a balanced (1:1) restricted randomization design to inhale either nitrous oxide (N2O) in a 50:50 mix with oxygen or medical air during the procedure. The main outcomes reported are the ECV success rate, degree of pain, adverse event rate, and women’s satisfaction. Trial registration: ClinicalTrials.gov Identifier: NCT01948115. Results The study included 150 women (nitrous oxide group: n = 74; medical air: n = 76). Inhaled nitrous oxide was not associated with a higher ECV success rate than medical air (24.3 vs 19.7%, P = 0.51). Among parous women (n = 34 in each group), the ECV success rate appeared higher in the nitrous oxide group, respectively 47.1% (n = 16) vs 23.5% (n = 8) (P = 0.042). Neither the median pain level nor adverse event rates differed significantly in women with inhaled nitrous oxide compared with medical air. Conclusions Use of an equimolar mixture of oxygen and nitrous oxide during ECV appears safe. Although it does not seem to change the overall success rate, it may increase success in parous women.

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“…Existen varias estrategias analgésicas estudiadas, como el óxido nitroso inhalado 24 , remifentanilo intravenoso 25 y la analgesia/anestesia regional 26,27 .…”

Section: Dolor En La Versión Cefálica Externa Y Uso De Analgesiaunclassified

Versión cefálica externa (actualizado marzo de 2014)

.¹

2015

Progresos de Obstetricia y Ginecología

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Sociedad Española de Ginecología y ObstetriciaDefinición Se denomina versión cefálica externa (VCE) al conjunto de maniobras que, mediante manipulación externa a través del abdomen materno, buscan convertir la presentación fetal en cefálica en aquellos fetos que se encuentren en una presentación diferente de esta. IntroducciónLa VCE es un procedimiento clásico que en los últimos años ha ganado importancia debido a los cambios que se han producido en el manejo de la presentación podálica a término.Existe consenso en la literatura en que un parto en cefálica es preferible a un parto en podálica o una cesárea. El objetivo de la VCE es transformar presentaciones no cefálicas en presentaciones cefálicas que tienen una mayor probabilidad de parto vaginal normal y menor riesgo de complicaciones.Dado que en un gran porcentaje de centros la presentación podálica equivale a la terminación de la gestación por vía abdominal, la VCE es un procedimiento que consigue eliminar el factor de riesgo obstétrico individual, aumentar las probabilidades de parto vaginal y ser una medida eficaz en la disminución de la tasa de cesáreas 1 . IndicacionesLa VCE está indicada en todas las gestantes que presenten un feto en presentación diferente de la cefálica a partir de la semana 37 y que no presenten ninguna contraindicación 2 .La VCE se debe realizar a término ( 37 semanas). Si bien practicar la versión a las 34-35 semanas se ha asociado a una mayor tasa de éxito, no conlleva una disminución de la tasa de cesáreas y puede aumentar el riesgo de parto pretérmino 2 . ContraindicacionesExiste poco consenso en la literatura en cuanto a las contraindicaciones para la VCE 3 . Si bien esto es así, hay ciertas circunstancias que son consideradas como contraindicaciones absolutas por la mayoría de los autores. Contraindicaciones absolutasSon pocas las situaciones en las que la VCE está absolutamente contraindicada:1. Situaciones que por sí mismas sean indicación de cesárea (placenta previa oclusiva, tumor previo, malformaciones fetales que condicionen la vía de parto, etc.). 2. Gestación múltiple. 3. Malformación uterina. 4. Feto muerto. 5. Compromiso fetal. 6. Antecedentes de desprendimiento de placenta o signos de desprendimiento placentario. 7. Preeclampsia grave/síndrome HELLP. 8. Isoinmunización Rh. 9. Oligoamnios severo (columna máxima < 2 cm). Contraindicaciones relativasEstas situaciones deberán ser evaluadas individualmente para decidir la idoneidad del procedimiento:

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Nitrous oxide for analgesia in external cephalic version at term: prospective comparative study^a

Abstract: N2O inhalation at a concentration of 50% for analgesia during ECV decreases the level of severe pain experienced by women, appears to be safe both for mother and child, and has no influence on the success rate of ECV or the perinatal outcomes.

Cited by 16 publications

References 23 publications

Increased pain relief with remifentanil does not improve the success rate of external cephalic version: a randomized controlled trial

Increased pain relief with remifentanil does not improve the success rate of external cephalic version: a randomized controlled trial

Effectiveness of nitrous oxide in external cephalic version on success rate: A randomized controlled trial

Versión cefálica externa (actualizado marzo de 2014)

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Nitrous oxide for analgesia in external cephalic version at term: prospective comparative studya

Abstract: N2O inhalation at a concentration of 50% for analgesia during ECV decreases the level of severe pain experienced by women, appears to be safe both for mother and child, and has no influence on the success rate of ECV or the perinatal outcomes.

Cited by 16 publications

References 23 publications

Increased pain relief with remifentanil does not improve the success rate of external cephalic version: a randomized controlled trial

Increased pain relief with remifentanil does not improve the success rate of external cephalic version: a randomized controlled trial

Effectiveness of nitrous oxide in external cephalic version on success rate: A randomized controlled trial

Versión cefálica externa (actualizado marzo de 2014)

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Nitrous oxide for analgesia in external cephalic version at term: prospective comparative study^a