Self-Administered Nitrous Oxide for Fracture Reduction in Children in an Emergency Room Setting

Wattenmaker, Ian; Kasser, James R.; Mcgravey, Ann

doi:10.1097/00005131-199003000-00006

Cited by 60 publications

(15 citation statements)

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“…A number of studies have trialled it, often against other techniques, for laceration repair, fracture reduction, dental procedures and vascular access 3 – 5 18 – 22. Most of this literature is with N 2 O and oxygen mixtures in concentrations of up to 50% via demand valve or continuous flow.…”

Section: Discussionmentioning

confidence: 99%

Limited analgesic efficacy of nitrous oxide for painful procedures in children

Babl

Oakley

Puspitadewi

et al. 2008

Emergency Medicine Journal

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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.

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Section: Discussionmentioning

confidence: 99%

Limited analgesic efficacy of nitrous oxide for painful procedures in children

Babl

Oakley

Puspitadewi

et al. 2008

Emergency Medicine Journal

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show abstract

“…4,5 Although less extensively studied, N 2 Obased sedation/analgesia [11][12][13] and lidocaine HB analgesia [18][19][20] have also been shown to provide effective reduction of pain and distress during forearm fracture reductions, especially in combination. 12 However, the 2 had not been compared previously.…”

Section: Efficacymentioning

confidence: 99%

“…11,13,24,25 The apparatus used in these studies and most commonly available for delivery of N 2 O in the emergency setting (Nitronox) requires patient generation of a sufficient negative pressure to open a demand valve to deliver a fixed 50% N 2 O/50%O 2 . The N 2 O/O 2 delivery device in the current study was a locally constructed valveless, continuous circuit apparatus that allowed variable delivery of N 2 O from 0% to 50% as the patient breathed normally.…”

Section: Efficacymentioning

confidence: 99%

“…11,13,24,25 Hennrikus et al 12 found that addition of a lidocaine fracture HB significantly augmented the effectiveness of the N 2 O sedation. HBs have been shown to be a safe and effective method to anesthetize a forearm fracture site before manipulation [18][19][20]27 and not to affect fracture healing 28 or increase the rate of infection when placed with sterile technique.…”

Section: Efficacymentioning

confidence: 99%

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A Randomized Comparison of Nitrous Oxide Plus Hematoma Block Versus Ketamine Plus Midazolam for Emergency Department Forearm Fracture Reduction in Children

Luhmann¹,

Schootman²,

Luhmann

et al. 2006

Pediatrics

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“…Children under 5 years have difficulty cooperating with the demand valve mask and, in the concentrations administered for PSA, nitrous oxide does not produce a reliable response in patients (56)(57)(58). Nitrous Oxide.…”

Section: Pharmacopeiamentioning

confidence: 99%

Management of acute pain and anxiety in children undergoing procedures in the emergency department

Krauss

2001

Pediatric Emergency Care

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This CME activity is intended for physicians who provide sedation and analgesia for procedures in the emergency department; including pediatricians, emergency physicians, and pediatric emergency physicians. LEARNING OBJECTIVES1. List the three most common indications for procedural sedation and analgesia (PSA) in the ED. 2. Describe the four general classes of agents used for PSA and their available routes of administration. 3. Discuss the potential adverse effects and contraindications to the use of PSA agents and antagonists. 4. Explain the different indications for topical anesthetics in PSA. 5. Discuss the future directions in pediatric PSA research and clinical practice.

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Self-Administered Nitrous Oxide for Fracture Reduction in Children in an Emergency Room Setting

Cited by 60 publications

References 0 publications

Limited analgesic efficacy of nitrous oxide for painful procedures in children

Limited analgesic efficacy of nitrous oxide for painful procedures in children

A Randomized Comparison of Nitrous Oxide Plus Hematoma Block Versus Ketamine Plus Midazolam for Emergency Department Forearm Fracture Reduction in Children

Management of acute pain and anxiety in children undergoing procedures in the emergency department

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