Nitrous oxide for analgesia in colonoscopy without sedation

Løberg, Magnus; Furholm, Siv; Hoff, Ingrid Elise; Aabakken, Lars; Hoff, Geir; Bretthauer, Michael

doi:10.1016/j.gie.2011.07.071

Cited by 20 publications

(13 citation statements)

References 27 publications

(34 reference statements)

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“…Pain at discharge following colonoscopy may be underreported as a result of patient expectations [20], cognitive impairment from the residual effects of the sedative and/or analgesic agents [38], and gender differences [47], all of which have been stated to affect patient report of intraoperative awareness. Some authors have suggested that colonoscopies be performed only with analgesic agents and omitting sedatives which may produce amnesia for the procedure without contributing to analgesic effect [14; 35]. Although most patients do not have subsequent conscious recall of pain experienced during the procedure when performed with sedation, up to 25% reportedly recall their procedural pain [12; 20; 40].…”

Section: Introductionmentioning

confidence: 99%

Brain measures of nociception using near-infrared spectroscopy in patients undergoing routine screening colonoscopy

Becerra

Aasted

Boas

et al. 2016

Pain

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Colonoscopy is an invaluable tool for screening and diagnosis of many colonic diseases. For most colonoscopies, moderate sedation is used during the procedure. However, insufflation of the colon produces a nociceptive stimulus that is usually accompanied by facial grimacing/groaning while under sedation. The objective of the current study was to evaluate whether a nociceptive signal elicited by colonic insufflation could be measured from the brain. Seventeen otherwise healthy patients (age 54.8±9.1; 6 female) undergoing routine colonoscopy (i.e., no history of significant medical conditions) were monitored using near-infrared spectroscopy (NIRS). Moderate sedation was produced using standard clinical protocols for midazolam and meperidine, titrated to effect. NIRS data captured during the procedure was analyzed offline to evaluate the brains’ responses to nociceptive stimuli evoked by the insufflation events (defined by physician or observing patients’ facial responses). Analysis of NIRS data revealed a specific, reproducible prefrontal cortex activity corresponding to times when patients grimaced. The pattern of the activation is similar to that previously observed during nociceptive stimuli in awake healthy individuals, suggesting that this approach may be used to evaluate brain activity evoked by nociceptive stimuli under sedation, when there is incomplete analgesia. While some patients report recollection of procedural pain following the procedure, the effects of repeated nociceptive stimuli in surgical patients may contribute to postoperative changes including chronic pain. The results from this study indicate that NIRS may be a suitable technology for continuous nociceptive afferent monitoring in patients undergoing sedation and could have applications under sedation or anesthesia.

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Section: Introductionmentioning

confidence: 99%

Brain measures of nociception using near-infrared spectroscopy in patients undergoing routine screening colonoscopy

Becerra

Aasted

Boas

et al. 2016

Pain

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“…Nitrous oxide sedation is currently used widely in clinical situations, including in emergency surgery, dentistry, childbirth, abortion and curettage, and pediatrics, and can also be applied for gastrointestinal endoscopic sedation. Nitrous oxide-sedated endoscopy examinations have been shown to be safe and effective[8-22], and nitrous oxide has proven a safe and effective choice for colonoscopy sedation and analgesia[8-10,12,17,19-22]. However, nitrous oxide is rarely used for EUS.…”

Section: Discussionmentioning

confidence: 99%

Randomized controlled study of the safety and efficacy of nitrous oxide-sedated endoscopic ultrasound-guided fine needle aspiration for digestive tract diseases

Wang¹,

Wang²,

Chen³

et al. 2016

WJG

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AIMTo evaluate the efficacy and safety of nitrous oxide-sedated endoscopic ultrasound-guided fine needle aspiration.METHODSEnrolled patients were divided randomly into an experimental group (inhalation of nitrous oxide) and a control group (inhalation of pure oxygen) and heart rate, blood oxygen saturation, blood pressure, electrocardiogram (ECG) changes, and the occurrence of complications were monitored and recorded. All patients and physicians completed satisfaction questionnaires about the examination and scored the process using a visual analog scale.RESULTSThere was no significant difference in heart rate, blood oxygen saturation, blood pressure, ECG changes, or complication rate between the two groups of patients (P > 0.05). However, patient and physician satisfaction were both significantly higher in the nitrous oxide compared with the control group (P < 0.05).CONCLUSIONNitrous oxide-sedation is a safe and effective option for patients undergoing endoscopic ultrasound-guided fine needle aspiration.

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“…Nitrous oxide has shown superiority over placebo in some studies [8,9], but in another study no analgesic effect could be demonstrated [30].…”

Section: Discussionmentioning

confidence: 99%

Nitrous oxide analgesia for bone marrow aspiration and biopsy – A randomized, controlled and patient blinded study

Kuivalainen

Ebeling

Poikonen

et al. 2015

Scandinavian Journal of Pain

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Background and aims Bone marrow aspiration and/or biopsy (BMAB), performed under local anaesthesia in adults, is a common and often painful procedure. Anxiety is known to intensify pain during the procedure. Nitrous oxide (N2O), known for its sedative and analgesic benefit in various short medical procedures and labour pain, could be advantageous also for pain relief during bone marrow examination. N2O acts rapidly and is eliminated in a couple of minutes once the inhalation is stopped, and occasional side effects (e.g. dizziness and nausea) are mild. The aim of this study was to compare the analgesic effects of inhaled 50% mixture of nitrous oxide and oxygen to 50% oxygen during bone marrow examination. Methods In this randomized, controlled, patient and observer blinded study patients received either 50% mixture of nitrous oxide and oxygen or 50% mixture of oxygen in air during bone marrow examination, in addition to local analgesia. Both patient groups comprised 35 adult patients. Pre-procedural anxiety and procedural pain were rated on the Numeral Rating Scale (NRS 0‒10). Cognitive function was measured before and 30 min after the procedure. Possible side effects were recorded. A telephone interview was performed 24 h later. Results There were no statistically significant differences in pain scores of the procedural steps (median NRS ranging 3.0‒4.0) between the study groups. High pain scores of 8‒10 comprised 0% vs. 8.6% of the scores during infiltration, 2.9% vs. 5.7% during puncture, 11.4% vs. 14.3% during aspiration and 2.9% vs. 2.9% during biopsy in N2O and 50% O2 groups, respectively (NS). Pre-procedural anxiety (median NRS 3.5 in both groups), measured in the outpatient clinic just prior to procedure, correlated with pain intensity during bone marrow aspiration (P = 0.045). There were no significant differences between side effects. During the BMAB four patients (3 in N2O group, 1 in 50% O2 group) reported dizziness and one patient in the N2O group reported nausea. Gas inhalation did not affect the cognitive function of the participants. In both groups the majority (>80%) of the patients was satisfied with the inhalation technique. During the 24 h interview, most of the participants were pain free and they did not report any serious adverse effects. Conclusions In spite of similar moderate to strong procedural pain in both groups and no benefit of N2O, most patients were satisfied with the inhalational techniques. We assume that the bedside presence of an anaesthesiologist and the distraction caused by the inhalational arrangements introduced positive context-sensitive therapeutic effect independent of the gas used. Pre-procedural anxiety predicted pain associated with bone marrow aspiration. Implications Inhaled 50% nitrous oxide was not an effective analgesic during bone marrow examination in our unselected outpatient population. Further studies should concentrate on its use with patients predicted to be at increased risk of suffering intense pain during the procedure, such as very anxious patients o...

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Nitrous oxide for analgesia in colonoscopy without sedation

Cited by 20 publications

References 27 publications

Brain measures of nociception using near-infrared spectroscopy in patients undergoing routine screening colonoscopy

Brain measures of nociception using near-infrared spectroscopy in patients undergoing routine screening colonoscopy

Randomized controlled study of the safety and efficacy of nitrous oxide-sedated endoscopic ultrasound-guided fine needle aspiration for digestive tract diseases

Nitrous oxide analgesia for bone marrow aspiration and biopsy – A randomized, controlled and patient blinded study

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