A Randomized Comparison of Nitrous Oxide Versus Intravenous Ketamine for Laceration Repair in Children

Abstract

Nitrous oxide inhalation was preferable to injectable ketamine for pediatric patients because it is safe, allows for a faster recovery, maintains sufficient sedation time, and does not induce unnecessarily deep sedation.

Sedation and Analgesia Using Medications Delivered via the Extravascular Route in Children Undergoing Laceration Repair

“…Lee et al 16 provided further support of the efficacy of N 2 O. Patients were randomized to 50% to 70% N 2 O or ketamine 2 mg/kg IV.…”

“…Fourteen studies provided data comparing sedatives and analgesics via the extravascular route to placebos or comparator agents and the sedatives and analgesics were noted to be efficacious. [3][4][5][6][7][8][9][10][11][12][13][14][15][16] Two studies compared combination therapy using PO midazolam. 17,18 It is difficult to compare the findings of these studies given the variability of sample size in the studies as well as the variety of agents, dosage forms, and dosing used.…”

Analgesia in Patients with Trauma in Emergency Medicine

“…Two RCTs compared the effect of N 2 O with that of ketamine or fentanyl (22,23) and described equivalent effect significantly more rapidly than morphine alone (17,21,39). However, two of the RCTs showed that pain reduction was comparable after 30 min (24,25).…”

Management of Pain in the Emergency Department

“…Based upon the recent literature, N 2 O may be poised for something of a comeback in the acute care setting [80,155,156,[164][165][166][167]. The agent is well known, self-administered, safe, and at least moderately effective.…”

“…Special scales that have been well described in the literature can be used for validated pain assessment (and thus enable appropriate analgesia provision) [79][80][81][82]. The lack of IV access can also be problematic.…”