Nitrous Oxide for the Management of Labor Pain

Likis, Frances E; Andrews, Jeffrey C; Collins, Michelle; Lewis, Rashona M.; Seroogy, Jeffrey J; Starr, Sarah A.; Walden, Rachel R.; McPheeters, Melissa L

doi:10.1097/01.sa.0000452765.43019.15

Cited by 11 publications

(25 citation statements)

References 4 publications

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“…Entonox which is a composition of 50% N 2 O and 50% O 2 compacted in cylindric containers was commercially introduced in 1961. During last decades, Entonox has gained considerable acceptance in many European and Asian countries [ 4 , 5 ]. The mechanism of its action is probably release of endorphin and dopamine in the brain which modulates pain stimuli via descending spinal and nerve pathways and in consequence reduces labor pain to a tolerable level [ 2 , 3 , 5 ].…”

Section: Introductionmentioning

confidence: 99%

Effects of Continuous Use of Entonox in Comparison with Intermittent Method on Obstetric Outcomes: A Randomized Clinical Trial

Agah

Baghani

Tali

et al. 2014

Journal of Pregnancy

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Background. Entonox (N2O2) which is an inhalational gas for relieving labor pain is commonly used intermittently; however some women are interested in continuous breathing in face mask. So we decided to compare the complications induced by two methods to find out whether it is safe to permit the mothers to use Entonox continuously or not. Patients and Methods. This randomized clinical trial was performed in Mobini Hospital, Sabzevar, Iran. 50 parturients used Entonox intermittently and 50 cases used it continuously during labor. Then obstetrical outcomes were analyzed in two groups by spss 17 software, t-test, and Chi2 while P < 0.05 was considered significant. Results. This study showed the mean duration of second stage of labor had no significant difference (P = 0.3). Perineal laceration was less in continuous group significantly (P = 0.04). Assisted vaginal birth was not different significantly (P = 0.4). Uterine atony had no significant difference in two groups (P = 0.2). Maternal collaboration in pushing and satisfaction were higher in continuous group significantly (P = 0.03), (P < 0.0001). Apgar score of neonates at first and fifth minute was acceptable and not different significantly in two groups (P = 0.3). Conclusions. Our study demonstrated continuous method is also safe. So, it seems reasonable to set mothers free to choose the desired method of Entonox usage.

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Section: Introductionmentioning

confidence: 99%

Effects of Continuous Use of Entonox in Comparison with Intermittent Method on Obstetric Outcomes: A Randomized Clinical Trial

Agah

Baghani

Tali

et al. 2014

Journal of Pregnancy

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“…19 Other studies have supported this finding by noting that intrapartum N 2 O use has no effect on fetal heart rate, umbilical cord gases, and Apgar scores. 5,6,20 The impact of N 2 O availability on the labor unit and correlation with rates of neuraxial analgesia use remains unclear. The study hospital had a consistent neuraxial analgesia rate of 66% for all women having a vaginal birth before and after hospital initiation of intrapartum N 2 O (author C.L.W., personal communication).…”

Section: Discussionmentioning

confidence: 99%

Nitrous Oxide Use During Labor: Satisfaction, Adverse Effects, and Predictors of Conversion to Neuraxial Analgesia

Nodine

Collins

Wood

et al. 2020

J Midwife Womens Health

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Introduction Women desire safe and effective choices for pain management during labor. Currently, neuraxial and opioid analgesia are the most common methods used in the United States. The purpose of this study was to investigate demographic characteristics, safety, and satisfaction in a cohort of parturients who used inhaled nitrous oxide (N2O) analgesia and to determine predictors of conversion from N2O to neuraxial analgesia. Methods This was a prospective chart review study. Individuals aged at least 18 years who used inhaled N2O during the first or second stage of labor between March 1, 2016, and July 23, 2017, on the labor and delivery unit of one academic medical center (N = 463) and their neonates were included. Data describing maternal and neonatal factors are reported. Logistic regression and chi‐square tests were used to model the effects of oxytocin augmentation, labor induction, parity, prior cesarean birth, pre‐N2O cervical dilatation, and post‐N2O cervical dilatation on the odds of conversion from N2O to neuraxial analgesia. Results In this cohort, 31% who chose N2O for analgesia did not convert to any other analgesic method. Significant positive predictors for conversion from N2O to neuraxial analgesia included labor induction (odds ratio [OR], 2.9; 95% CI, 1.7‐5.0), oxytocin augmentation (OR, 3.1; 95% CI, 1.6‐6.0), and labor after cesarean (OR, 6.4; 95% CI, 2.5‐16.5). Multiparity (OR, 0.4; 95% CI, 0.2‐0.6) and post‐N2O cervical dilatation (OR, 0.8; 95% CI, 0.7‐0.9) were negative predictors. Adverse effects related to N2O use during labor were rare (8%) and were not a significant reason for conversion to neuraxial analgesia. Parturients had moderately high satisfaction with N2O for pain management (11‐point scale, mean [SD], 7.4 [2.9]). Five‐minute Apgar scores were 7 or greater in 97.8% of the newborns. Discussion Understanding predictors of conversion from inhaled N2O to neuraxial analgesia may assist perinatal care providers in their discussions with women about analgesia options during labor. N2O is a useful, safe option for labor analgesia in the United States.

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“…These results suggest that pain relief alone is not the only contributor to satisfaction with the childbirth experience. In a 2012 systematic review for the Agency of Healthcare Research and Quality, Likis et al (2012) noted that use of N 2 O provided less effective pain relief during labor and birth than epidural analgesia, but the quality of studies was predominately poor. These investigators also found insufficient evidence to determine the effectiveness of N 2 O compared with nonepidural labor pain management methods because studies were predominately poor quality, used heterogenous outcome measures, and had inconsistent findings (Likis et al, 2012).…”

Section: Pain Management During Labor and Birthmentioning

confidence: 99%

“…In a 2012 systematic review for the Agency of Healthcare Research and Quality, Likis et al (2012) noted that use of N 2 O provided less effective pain relief during labor and birth than epidural analgesia, but the quality of studies was predominately poor. These investigators also found insufficient evidence to determine the effectiveness of N 2 O compared with nonepidural labor pain management methods because studies were predominately poor quality, used heterogenous outcome measures, and had inconsistent findings (Likis et al, 2012). Nitrous oxide may be used with other methods of analgesia, including hydrotherapy; movement; massage; therapeutic touch techniques, such as effleurage, acupuncture, acupressure; aromatherapy; and psychoprophylactic methods.…”

Section: Pain Management During Labor and Birthmentioning

confidence: 99%