The use of inhaled nitrous oxide for analgesia in adult ED patients: a pilot study

Herres, Joseph; Chudnofsky, Carl R.; Manur, Rashmi; Damiron, Kathia; Deitch, Kenneth

doi:10.1016/j.ajem.2015.10.038

Cited by 16 publications

(10 citation statements)

References 21 publications

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“…Due to the increased vigilance about the potential long‐term risks of opioids, the search for alternative evidence‐based medications to manage various types of acute pain is essential. Recent literature evaluated the analgesic effects of opioid alternatives such as antidepressants, ketamine, and nitrous oxide . However, lidocaine remains an attractive option due to its analgesic and antiinflammatory properties.…”

Section: Discussionmentioning

confidence: 99%

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Intravenous Lidocaine for Acute Pain: A Systematic Review

et al. 2018

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This systematic review evaluates the safety and efficacy of intravenous (IV) lidocaine for the treatment of acute pain in adult patients. The PubMed database was searched for randomized controlled trials, retrospective cohort studies, case series, and case reports evaluating the use of IV lidocaine for the treatment of acute pain in adult patients, published between January 1970 and January 2018. The primary outcome was pain reduction via the Visual Analog Scale, Verbal Rating Scale, or Numeric Rating Scale among patients treated with IV lidocaine and placebo or active controls. Safety outcomes included both nonserious and serious adverse events. A total of 347 titles and abstracts were screened, and after full‐text review, 13 studies met the inclusion criteria involving 512 patients. The four active controls studied were IV morphine, IV ketorolac, IV dihydroergotamine (DHE), and IV chlorpromazine (CPZ). The dosing of IV lidocaine varied among studies between a weight‐based dose of a 1‐ to 2‐mg/kg bolus, a fixed‐bolus dose of 50–100 mg, and a 1‐mg/kg/hour continuous infusion. Monitoring of serum lidocaine concentrations was not done routinely. Intravenous lidocaine had superior efficacy to morphine for renal colic and critical limb ischemia, superior efficacy to DHE for acute migraine, and equivalent efficacy to ketorolac for acute radicular lower back pain. However, lidocaine was less effective than CPZ for the treatment of acute migraine. The most common adverse event reported among all studies were neurologic effects such as altered mental status and slurred speech. Due to the inconsistency in dosing, length of administration, and lack of serum monitoring, the absolute safety of IV lidocaine for acute pain is unknown. Larger, prospective studies are needed before the routine use of IV lidocaine can be recommended for all types of acute pain.

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Section: Discussionmentioning

confidence: 99%

“…Recent literature evaluated the analgesic effects of opioid alternatives such as antidepressants, 34 ketamine, 35 and nitrous oxide. 36 However, lidocaine remains an attractive option due to its analgesic and antiinflammatory properties.…”

Section: Discussionmentioning

confidence: 99%

Intravenous Lidocaine for Acute Pain: A Systematic Review

et al. 2018

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“…On note tout d'abord une difficulté à la tracer (réévaluation peu fréquente) et aucune retranscription dans près d'un quart des dossiers (23 %). La [11][12][13]. L'analyse univariée a par ailleurs retrouvé un lien entre la prescription de MEOPA plutôt prescrit chez les patients jeunes en comparaison aux autres antalgiques.…”

Section: Discussionunclassified

Luxations aiguës d'épaule : évaluation rétrospective aux urgences et proposition d'un protocole de sédation procédurale

Guillot

Borgne

Kauffmann

et al. 2018

Ann. Fr. Med. Urgence

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Introduction : Les luxations d'épaule sont des pathologies fréquentes aux urgences, parmi les plus douloureuses et pour lesquelles il n'existe pas de recommandations spécifiques. Elles représentent 45 % de l'ensemble des luxations. L'objectif principal de cette étude était d'analyser la gestion de la douleur dans cette pathologie. Matériel et méthodes : Nous avons conduit une étude observationnelle, monocentrique et rétrospective colligeant 238 patients ayant consulté aux urgences pour une luxation aiguë d'épaule (01/01/2012-30/04/2015). Les luxations réduites spontanément, les luxations sur prothèse et les luxations chroniques étaient exclues de l'étude. Résultats : Les luxations aiguës d'épaule étaient majoritairement réduites aux urgences (90 %, IC95 % : [86-94]). Il s'agissait d'une pathologie hyperalgique (Echelle numérique médiane : 8/10, [EIC : 6-9]) touchant plutôt les sujets jeunes (âge médian : 48 ans, EIC : 28-73). Il existait une grande hétérogénéité dans la répartition des antalgiques utilisés, le mélange équimolaire d'oxygène et de protoxyde d'azote (MEOPA) était l'antalgique le plus prescrit (50 % (IC95 % : [42-55])), suivi par le paracétamol (25 %) et le néfopam (15 %). Dans le sous-groupe des luxations compliquées d'une fracture, le MEOPA était également le plus prescrit. La répartition des autres antalgiques était par ailleurs similaire. Enfin, la comparaison entre les deux équipes médicales (urgentiste vs orthopédiste) ne retrouvait aucune différence de prescription en dehors du midazolam davantage utilisé par les urgentistes (16 % vs 4 %, p=0,001). Conclusion : Il existait une grande hétérogénéité des pratiques et une sous-utilisation d'antalgiques et d'hypnotiques malgré des douleurs importantes dès l'admission. Un chemin clinique visant à améliorer cette prise en charge est proposé afin d'homogénéiser les pratiques.

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“…In a recent non-controlled pilot study of self-administered nitrous oxide among 85 ED patients with abscesses or orthopedic injuries, nitrous oxide appeared to be safe and well tolerated. Given the current emphasis on decreasing opioid use in the ED, it is likely that nitrous oxide use will increase over time [ 49 ].…”

Section: Emerging Treatments and Approachesmentioning

confidence: 99%

A Review of Current and Emerging Approaches to Pain Management in the Emergency Department

Todd

2017

Pain Ther

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IntroductionPain is the most common symptom prompting an emergency department visit and emergency physicians are responsible for managing both acute pain and acute exacerbations of chronic pain resulting from a broad range of illnesses and injuries. The responsibility to treat must be balanced by the duty to limit harm resulting from analgesics. In recent years, opioid-related adverse effects, including overdose and deaths, have increased dramatically in the USA. In response to the US opioid crisis, emergency physicians have broadened their analgesic armamentarium to include a variety of non-opioid approaches. For some of these therapies, sparse evidence exists to support their efficacy for emergency department use. The purpose of this paper is to review historical trends and emerging approaches to emergency department analgesia, with a particular focus on the USA and Canada.MethodsWe conducted a qualitative review of past and current descriptive studies of emergency department pain practice, as well as clinical trials of emerging pain treatment modalities. The review considers the increasing use of non-opioid and multimodal analgesic therapies, including migraine therapies, regional anesthesia, subdissociative-dose ketamine, nitrous oxide, intravenous lidocaine and gabapentinoids, as well as broad programmatic initiatives promoting the use of non-opioid analgesics and nonpharmacologic interventions.ResultsWhile migraine therapies, regional anesthesia, nitrous oxide and subdissociative-dose ketamine are supported by a relatively robust evidence base, data supporting the emergency department use of intravenous lidocaine, gabapentinoids and various non-pharmacologic analgesic interventions remain sparse.ConclusionAdditional research on the relative safety and efficacy of non-opioid approaches to emergency department analgesia is needed. Despite a limited research base, it is likely that non-opioid analgesic modalities will be employed with increasing frequency. A new generation of emergency physicians is seeking additional training in pain medicine and increasing dialogue between emergency medicine and pain medicine researchers, educators and clinicians could contribute to better management of emergency department pain.

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The use of inhaled nitrous oxide for analgesia in adult ED patients: a pilot study

Cited by 16 publications

References 21 publications

Intravenous Lidocaine for Acute Pain: A Systematic Review

Intravenous Lidocaine for Acute Pain: A Systematic Review

Luxations aiguës d'épaule : évaluation rétrospective aux urgences et proposition d'un protocole de sédation procédurale

A Review of Current and Emerging Approaches to Pain Management in the Emergency Department

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