Abstract
Background
Acute pain is the most common complaint in Emergency Department (ED) admissions, and
options for analgesia are limited. Nitrous oxide/oxygen possesses many properties
showing it may be an ideal analgesic in the ED.
Objectives
The aim of this study is to evaluate the safety and analgesic effect of the fixed
nitrous oxide/oxygen mixture for trauma patients in the ED.
Methods
We enrolled 60 patients in this double-blind, randomized study. The treatment group
received conventional pain treatment plus a mixture of 65% nitrous oxide/oxygen. The
control group received the conventional pain treatment plus oxygen. Primary outcome
was the reduction in pain intensity at 5 and 15 min after the start of intervention.
Secondary outcomes include adverse events, physiological parameters, and satisfaction
from both patients and health care professionals.
Results
Initial pain scores for the nitrous oxide/oxygen group (6.0 [5.0–8.0]) and the oxygen
group (6.75 [5.0–9.0]) were comparable (p = 0.57). The mean numerical rating scale scores at 5 min were 3.4 ± 1.8 and 7.0 ± 1.8
for nitrous oxide/oxygen and oxygen, respectively (p < 0.01). The mean pain intensity at 15 min in the treatment group was 3.0 ± 1.9,
compared with 6.3 ± 2.2 in the control group (p < 0.01). Both patients' (8.0 [7.0–9.0] vs. 4.0 [2.0–6.0], p < 0.01) and physicians’ (8.5 [8.0–9.0] vs. 4.0 [3.0–6.0], p < 0.01) satisfaction scores in the treatment group were significantly higher than
the oxygen group. No serious adverse events were observed.
Conclusions
This study gives supporting evidence for the safety and effectiveness of using self-administered
nitrous oxide/oxygen mixture in the ED for moderate-to-severe traumatic pain.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Emergency MedicineAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- The use of inhaled nitrous oxide for analgesia in adult ED patients a pilot study.Am J Emerg Med. 2016; 34: 269-270
- Patient and health care provider responses from a prospective, double-blind, randomized controlled trial comparing vapocoolant spray versus placebo spray in adults undergoing venipuncture in the emergency department.Pain Manag Nurs. 2018; 19: 391-399
- Pain in the emergency department: results of the pain and emergency medicine initiative (PEMI) multicenter study.J Pain. 2007; 8: 460-466
- Survey of pain etiology, management practices and patient satisfaction in two urban emergency departments.Can J Emerg Med. 2002; 4: 252-256
- Mandated pain scales improve frequency of ED analgesic administration.Am J Emerg Med. 2004; 22: 582-585
- Pediatric emergency department analgesic practice.Pediatr Emerg Care. 1997; 13: 103-106
- Patterns of analgesic use in trauma patients in the ED.Am J Emerg Med. 2002; 20: 298-302
- Patient expectations for pain relief in the ED.Am J Emerg Med. 2004; 22: 286-288
- Quality indicators for the assessment and management of pain in the emergency department: a systematic review.Pain Res Manag. 2014; 19: e179-e190
- The pathophysiology of acute pain.Emerg Med Clin North Am. 2005; 23: 277-284
- The experience and understanding of pain management in recently discharged adult trauma patients: a qualitative study.Injury. 2018; 49: 110-116
- Nitrous oxide sedation/analgesia in emergency medicine.Ann Emerg Med. 1985; 14: 139-148
- Self-administered nitrous oxide analgesia for pediatric fracture reductions.J Pediatr Orthop. 1994; 14: 538-542
- Nitrous oxide, from the operating room to the emergency department.Curr Emerg Hosp Med Rep. 2016; 4: 11-18
- Nitrous oxide for early analgesia in the emergency setting: a randomized, double-blind multicenter prehospital trial.Acad Emerg Med. 2013; 20: 178-184
- Nitrous oxide-oxygen mixture during burn wound dressing: a double-blind randomized controlled study.CNS Neurosci Ther. 2013; 19: 278-279
- Management of a pain in the emergency department.ISRN Emerg Med. 2013; (Available at:)
- A fixed inhaled nitrous oxide/oxygen mixture as an analgesic for adult cancer patients with breakthrough pain: study protocol for a randomized controlled trial.Trials. 2017; 18: 13
- Nitrous oxide/oxygen mixture for analgesia in adult cancer patients with breakthrough pain: a randomized, double-blind controlled trial.Eur J Pain. 2017; 22: 492-500
- Efficacy of lidocaine in patients receiving palliative care with opioid refractory cancer pain with a neuropathic component: study protocol for a randomized controlled study.Trials. 2014; 15: 318
- Sample size calculation in clinical eesearch.3rd edn. Marcel Dekker, New York2003
- An improved approximate formula for calculating sample sizes for comparing two binomial distributions.Biometrics. 1978; 34: 483-486
- Nitrous oxide/oxygen inhalation provides effective analgesia during the administration of tumescent local anaesthesia for endovenous laser ablation.Vasa. 2015; 44: 473-478
- Nitrous oxide/oxygen compared with fentanyl in reducing pain among adults with isolated extremity trauma: a randomized trial.Emerg Med Australas. 2011; 23: 761-768
- A 50–50% mixture of nitrous oxide-oxygen in transrectal ultrasound-guided prostate biopsy: a randomized and prospective clinical trial.PLoS One. 2018; 13: e0195574
- Randomized controlled study of the safety and efficacy of nitrous oxide-sedated endoscopic ultrasound-guided fine needle aspiration for digestive tract diseases.World J Gastroenterol. 2016; 22: 10242-10248
- Studying protocol-based pain management in the emergency department.J Emerg Trauma Shock. 2017; 10: 180-188
- Increased analgesia administration in emergency medicine after implementation of revised guidelines.Int J Emerg Med. 2016; 9: 4
Article info
Publication history
Published online: September 09, 2019
Accepted:
June 15,
2019
Received in revised form:
June 11,
2019
Received:
March 12,
2019
Identification
Copyright
© 2019 Published by Elsevier Inc.
