Minor procedures in the accident and emergency department: can Entonox help?

Abstract

SUMMARYThe efficacy of Entonox as a supplement to local anaesthesia for minor surgical procedures was studied. Eighty-five patients undergoing surgery for the incision and drainage of a subcutaneous abscess using a local anaesthetic were involved in a trial to ascertain the level of pain associated with such procedures and to investigate the possibility of using on-demand Entonox to supplement the local anaesthesia provided. Patients received either the standard local anaesthesia, or, alternatively, the local anaesthesia was supplemented with oxygen or Entonox via on-demand apparatus.Patients indicated on three linear visual analogue scales their pain, anxiety and total discomfort, and also on a cartoon pain rating scale, at different stages during the operation.Results showed that there was no statistically significant reduction in pain provided by the Entonox, despite general patient approval. Both oxygen and Entonox showed some anxiolytic properties. Pure oxygen was also seen to produce a rise in heart rate, while both gases (pure oxygen and Entonox) caused an increase in diastolic blood pressure. It was also seen that the patient's short term memory of the pain experienced was unaffected by pure oxygen or Entonox.

Nitrous oxide/oxygen compared with fentanyl in reducing pain among adults with isolated extremity trauma: A randomized trial

“…Given its limited side effects with short-term administration of this drug, its use in other hospital settings should be considered. A number of studies 12,13,[17][18][19] have compared nitrous oxide/oxygen and opioids and have reported on nitrous oxide's relative efficacy and safety in emergency setting. In our study we compared the analgesic efficacy and side effects of nitrous oxide/oxygen with a single dose of fentanyl in ED patients suffering isolated extremity trauma.…”

Nitrous oxide in emergency medicine

“…11 12 [level 2b]. It has also been used for the relief of pain from musculoskeletal injuries, wound care, suture removal, ureteric colic, acute abdominal pain, 13 [level 2b] and some uncomfortable diagnostic procedures.…”

Inhaled nitrous oxide versus placebo as an analgesic and anxiolytic adjunct to peripheral intravenous cannulation

“…1 Both of these can be painful, and may produce lasting effects necessitating close monitoring for extended periods. In addition to pain, such procedures may produce significant anxiety, 2 generating unpleasant memories for the patient and making the performance of the procedure difficult for the health care provider.…”