Patient-Administered Nitrous Oxide/Oxygen Inhalation Provides Safe and Effective Analgesia for Percutaneous Liver Biopsy: A Randomized Placebo-Controlled Trial

Castéra, Laurent; Nègre, Isabelle; Samii, Kamran; Buffet, Catherine

doi:10.1111/j.1572-0241.2001.03776.x

Cited by 61 publications

(56 citation statements)

References 28 publications

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“…In adults, N 2 O in oxygen has some analgesic efficacy in labour (Rosen, 2002 Level I) and is effective during painful procedures such as bone marrow aspiration (Gudgin et al, 2008 Level III-3), venous cannulation Level II), sigmoidoscopy (Harding & Gibson, 2000 Level II) and liver biopsy (Castera et al, 2001 Level II), and in relieving acute ischaemic chest…”

Section: Nitrous Oxidementioning

confidence: 99%

Acupuncture for analgesia in the emergency department: a multicentre, randomised, equivalence and non‐inferiority trial

Cohen

Smit

Andrianopoulos³

et al. 2017

Medical Journal of Australia

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Objectives: This study aimed to assess analgesia provided by acupuncture, alone or in combination with pharmacotherapy, to patients presenting to emergency departments with acute low back pain, migraine or ankle sprain. Design: A pragmatic, multicentre, randomised, assessor‐blinded, equivalence and non‐inferiority trial of analgesia, comparing acupuncture alone, acupuncture plus pharmacotherapy, and pharmacotherapy alone for alleviating pain in the emergency department. Setting, participants: Patients presenting to emergency departments in one of four tertiary hospitals in Melbourne with acute low back pain, migraine, or ankle sprain, and with a pain score on a 10‐point verbal numerical rating scale (VNRS) of at least 4. Main outcome measures: The primary outcome measure was pain at one hour (T1). Clinically relevant pain relief was defined as achieving a VNRS score below 4, and statistically relevant pain relief as a reduction in VNRS score of greater than 2 units. Results: 1964 patients were assessed between January 2010 and December 2011; 528 patients with acute low back pain (270 patients), migraine (92) or ankle sprain (166) were randomised to acupuncture alone (177 patients), acupuncture plus pharmacotherapy (178) or pharmacotherapy alone (173). Equivalence and non‐inferiority of treatment groups was found overall and for the low back pain and ankle sprain groups in both intention‐to‐treat and per protocol (PP) analyses, except in the PP equivalence testing of the ankle sprain group. 15.6% of patients had clinically relevant pain relief and 36.9% had statistically relevant pain relief at T1; there were no between‐group differences. Conclusion: The effectiveness of acupuncture in providing acute analgesia for patients with back pain and ankle sprain was comparable with that of pharmacotherapy. Acupuncture is a safe and acceptable form of analgesia, but none of the examined therapies provided optimal acute analgesia. More effective options are needed. Trial registration: Australian New Zealand Clinical Trials Registry, ACTRN12609000989246.

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Section: Nitrous Oxidementioning

confidence: 99%

Acupuncture for analgesia in the emergency department: a multicentre, randomised, equivalence and non‐inferiority trial

Cohen

Smit

Andrianopoulos³

et al. 2017

Medical Journal of Australia

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“…However, liver biopsy is an invasive procedure, associated with pain in around 30% of cases [3][4][5], and potentially life-threatening complications (hemorrhage in 0.3% of cases and mortality in 0.01%) [6]. The accuracy of liver biopsy to assess fibrosis has also been questioned in relation to sampling errors and intra-and inter-observer variability that may lead to over-or under-staging [7][8][9][10].…”

Section: Introductionmentioning

confidence: 99%

Non-invasive assessment of liver fibrosis in chronic hepatitis C

Castéra

2011

Hepatol Int

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“…Indeed, two endpoints are clinically relevant: (i) the presence of significant fibrosis, which is the hallmark of progressive disease and an indication for antiviral treatment; (ii) the presence of cirrhosis, which is an indication for specific monitoring of complications related to portal hypertension and to the increased risk of developing hepatocellular carcinoma [4]. Liver biopsy (LB) is classically considered the gold standard for staging fibrosis [5], although it has several limitations: it is an invasive and painful procedure [6][7][8], with rare but potentially life-threatening complications [9], and prone to sampling errors [10][11][12]. Thus, many patients are reluctant to undergo LB, especially HIV/HCV-coinfected patients who may be discouraged from initiating anti-HCV treatment for this reason.…”

mentioning

confidence: 99%

Comparison of transient elastography (FibroScan), FibroTest, APRI and two algorithms combining these non‐invasive tests for liver fibrosis staging in HIV/HCV coinfected patients: ANRS CO13 HEPAVIH and FIBROSTIC collaboration

et al. 2013

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ObjectivesCombining noninvasive tests increases diagnostic accuracy for staging liver fibrosis in hepatitis C virus (HCV)-infected patients, but this strategy remains to be validated in HIV/HCV coinfection. We compared the performances of transient elastography (TE), Fibrotest (FT), the aspartate aminotransferase-to-platelet ratio index (APRI) and two algorithms combining TE and FT (Castera) or APRI and FT (SAFE) in HIV/HCV coinfection. MethodsOne hundred and sixteen HIV/HCV-coinfected patients (64% male; median age 44 years) enrolled in two French multicentre studies (the HEPAVIH cohort and FIBROSTIC) for whom TE, FT and APRI data were available were included in the study. Diagnostic accuracies for significant fibrosis (METAVIR F ≥ 2) and cirrhosis (F4) were evaluated by measuring the area under the receiver-operating characteristic curve (AUROC) and calculating percentages of correctly classified (CC) patients, taking liver biopsy as a reference. ResultsFor F ≥ 2, both TE and FT (AUROC = 0.87 and 0.85, respectively) had a better diagnostic performance than APRI (AUROC = 0.71; P < 0.005). Although the percentage of CC patients was significantly higher with Castera's algorithm than with SAFE (61.2% vs. 31.9%, respectively; P < 0.0001), this percentage was lower than that for TE (80.2%; P < 0.0001) or FT (73.3%; P < 0.0001) taken separately. For F4, TE (AUROC = 0.92) had a better performance than FT (AUROC = 0.78; P = 0.005) or APRI (AUROC = 0.73; P = 0.025). Although the percentage of CC patients was significantly higher with the SAFE algorithm than with Castera's (76.7% vs. 68.1%, respectively; P < 0.050), it was still lower than that for TE (85.3%; P < 0.033). ConclusionsIn HIV/HCV-coinfected patients, TE and FT have a similar diagnostic accuracy for significant fibrosis, whereas for cirrhosis TE has the best accuracy. The use of the SAFE and Castera algorithms does not seem to improve diagnostic performance. On average, nearly half of patients have developed liver cirrhosis after 25 years of HCV infection. Assessment of liver fibrosis is thus of critical importance in HIV/HCV-coinfected patients not only for prognosis but also for antiviral therapy indications. Indeed, two endpoints are clinically relevant: (i) the presence of significant fibrosis, which is the hallmark of progressive disease and an indication for antiviral treatment; (ii) the presence of cirrhosis, which is an indication for specific monitoring of complications related to portal hypertension and to the increased risk of developing hepatocellular carcinoma [4]. Liver biopsy (LB) is classically considered the gold standard for staging fibrosis [5], although it has several limitations: it is an invasive and painful procedure [6][7][8], with rare but potentially life-threatening complications [9], and prone to sampling errors [10][11][12]. Thus, many patients are reluctant to undergo LB, especially HIV/HCV-coinfected patients who may be discouraged from initiating anti-HCV treatment for this reason.These limitations have stimulated the search fo...

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Patient-Administered Nitrous Oxide/Oxygen Inhalation Provides Safe and Effective Analgesia for Percutaneous Liver Biopsy: A Randomized Placebo-Controlled Trial

Abstract: Patient-administered N2O/O2 inhalation provides safe and effective analgesia, at a reasonable cost, for PLB. Its routine use could be useful for the management of patients with chronic liver disease undergoing PLB as it may enhance patients compliance with future biopsies.

Cited by 61 publications

References 28 publications

Acupuncture for analgesia in the emergency department: a multicentre, randomised, equivalence and non‐inferiority trial

Acupuncture for analgesia in the emergency department: a multicentre, randomised, equivalence and non‐inferiority trial

Non-invasive assessment of liver fibrosis in chronic hepatitis C

Comparison of transient elastography (FibroScan), FibroTest, APRI and two algorithms combining these non‐invasive tests for liver fibrosis staging in HIV/HCV coinfected patients: ANRS CO13 HEPAVIH and FIBROSTIC collaboration

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