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

Kariman, Hamid; Majidi, Alireza; Amini, Afshin; Dolatabadi, Ali Arhami; Derakhshanfar, Hojjat; Hatamabadi, Hamidreza; Shahrami, Ali; Yaseri, Mehdi; Sheibani, Kourosh

doi:10.1111/j.1742-6723.2011.01447.x

Cited by 38 publications

(35 citation statements)

References 18 publications

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“…In a clinical trial, Kariman et al evaluated the effect of 50% Nitrous Oxide/Oxygen compared with fentanyl in reducing the pain caused by bone fractures. The results of this study have shown that the effect of nitrous oxide is similar with Fentanyl and also the complications of these 2 medicines show a significant difference (15). Furthermore, in another clinical trial, Ducasse et al evaluated the effect of nitrous oxide %50 in pain management of patients with trauma.…”

Section: Discussionmentioning

confidence: 93%

A Comparison between the Analgesic - Sedative Effects of Ketamine and Nitrous Oxide in Bones’ Fracture Pain Control: A Randomized Clinical Trial

Motamed

Barzegari

Verki

et al. 2017

Jundishapur J Nat Pharm Prod

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Background: Analgesics such as opioids are commonly used for pain control in emergency departments. correlated respiratory side effects and central nervous system depression confine opioids application as analgesic medication. New pain control choices such as Nitric oxide and Ketamine may be alternatives. This study evaluates efficacy of Nitric Oxide versus Ketamine in purpose of pain reduction in limbs fractures. Methods: In a randomized clinical study, 75 patients that were referred to the emergency department with pain, which has been caused by bone fractures, were randomly assigned into 2 groups: receiving ketamine with an intravenous bolus dose of 0.3 mg/kg versus mixture of 50% nitrous oxide/50% Oxygen. The pain score in the groups were measured and compared by the Visual Analog Scale consecutively at arrival and 5, 10, 15 minutes after intervention. Results: Fifteen minutes after the intervention, the score of pain in patients receiving ketamine, reached 2.5 from 8.86 at the baseline. This is while in the second group, 15 minutes after the treatment, reached to 5.02 from 9.52 at the baseline. The amount of pain reduction in both groups was statistically significant. A point-by-point comparison of the amount of the pain did not show significant differences in both groups. Conclusions: The findings of this study showed that both ketamine and Nitrous Oxide/Oxygen mixture are effective in alleviating the pain of patients with limb's fracture, however, there is no precedence between these medications as a pain killer.

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Section: Discussionmentioning

confidence: 93%

A Comparison between the Analgesic - Sedative Effects of Ketamine and Nitrous Oxide in Bones’ Fracture Pain Control: A Randomized Clinical Trial

Motamed

Barzegari

Verki

et al. 2017

Jundishapur J Nat Pharm Prod

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“…Selection of ideal and relatively pain-free reduction method could play a key role in management of shoulder dislocations. Intravenous sedation-analgesia (IVSA) is commonly applied for reduction in EDs and provide a trouble-free condition 1, 4, 6, 7, 8, 9, 10, 11. Studies showed that IVSA can trigger some side effects such as central nervous system and cardio-respiratory depression, which requires close patient monitoring and medical management 4, 6.…”

Section: Introductionmentioning

confidence: 99%

Intra-articular lidocaine versus intravenous sedative and analgesic for reduction of anterior shoulder dislocation

Kashani

Zarchi

Hatamabadi

et al. 2016

Turkish Journal of Emergency Medicine

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ObjectiveThis prospective clinical trial was performed to compare the safety and efficiency of intra-articular lidocaine (IAL) versus intravenous sedative and analgesic (IVSA) in reduction of anterior shoulder dislocation.Materials and methodsPatients with anterior shoulder dislocation were randomly divided into 2 groups to receive IAL and IVSA. One group patients received an intravenous dose of 0.05 mg/kg midazolam and 1 μg/kg fentanyl, while the other group received 20 mL intra-articular lidocaine (1%). Patient satisfaction (via a standard 5-choice questionnaire), pain score (based on visual analog scale ranging from 0 to 10 points), comfort reduction, recovery time, and side effects were recorded and compared between the two groups before, during and after the reduction procedure.ResultsTotally 104 patients with acute anterior shoulder dislocation and the mean age of 28.75 ± 7.24 years were included (86.5% male). There was no statistically significant difference between IAL and IVSA groups regarding age (p = 0.45) and gender (p = 0.25). A total of forty-seven (45.2%) patients, distributed in both groups, had a history of anterior shoulder dislocation. A significant difference was seen with regard to diminished pain intensity during reduction in IAL group (p < 0.001); Complications including nausea, apnea, hypoxia and headache were only observed in IVSA group, and there was no adverse effect in IAL group; increased patient satisfaction in IVSA group (p = 0.007); similar success rate at first attempt of reduction in both groups, and a shorter time to discharge in IAL group (p < 0.001).ConclusionIt seems that the use of intra-articular lidocaine for reduction of anterior shoulder dislocation is effective, safe, and time saving in the emergency department and has few complications. It can be considered as the first line analgesia in managing anterior shoulder dislocation.

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“…More recently, in an emergency setting, a study compared N 2 O and fentanyl, but the study had multiple limitations (unblinded design, analgesia delayed until after x-ray diagnosis, and nonconsecutive patients). 7 The goal of this investigation was to evaluate the efficacy of N 2 O and oxygen compared to medical air (MA) for prehospital treatment of adult patients with moderate traumatic acute pain. The primary outcome variable was the percentage of patients experiencing analgesia (defined by a numeric rating scale [NRS] score of 3 of 10 or lower) at 15 minutes.…”

mentioning

confidence: 99%

Nitrous Oxide for Early Analgesia in the Emergency Setting: A Randomized, Double‐blind Multicenter Prehospital Trial

Ducassé

Siksik²,

Durand-Bechu

et al. 2013

Academic Emergency Medicine

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Objectives: Although 50% nitrous oxide (N 2 O) and oxygen is a widely used treatment, its efficacy had never been evaluated in the prehospital setting. The objective of this study was to demonstrate the efficacy of premixed N 2 O and oxygen in patients with out-of-hospital moderate traumatic acute pain.Methods: This prospective, randomized, multicenter, double-blind trial enrolled patients with acute moderate pain (numeric rating scale [NRS] score between 4 and 6 out of 10) caused by trauma. Patients were assigned to receive either 50/50 N 2 O and oxygen 9 L/min (N 2 O group) or medical air (MA) 9 L/min (MA group), in ambulances from two nurse-staffed fire department centers. After the first 15 minutes, every patient received N 2 O and oxygen. The primary endpoint was pain relief at 15 minutes (T15), defined as a NRS 3 of 10. The NRS was measured every 5 minutes. Secondary endpoints were treatment safety and adverse events, time to analgesia, and patient and investigator satisfaction with analgesia.Results: Sixty patients were included with no differences between groups in age (median = 34 years, interquartile range [IQR] = 23 to 53 years), sex (37 males, 66%), and initial median NRS of 6 (IQR = 5 to 6). At T15, 67% of the patients in the N 2 O group had an NRS score of 3 or lower versus 27% of those in the MA group (delta = 40%, 95% confidence interval [CI] = 17% to 63%; p < 0.001). The median pain scores were lower in the N 2 O group at T15, 2 (IQR = 1 to 4) versus 5 (IQR = 3 to 6). There was a difference at 5 minutes that persisted at all subsequent time points. Four patients (one in the N 2 O group) experienced adverse events (nausea) during the protocol. 1 For a number of years, many rescue organizations throughout the world, including some employing caregivers not trained as emergency medical technicians, have made use of 50% nitrous oxide (N 2 O) and oxygen analgesia.2 There has been limited clinical evidence for the efficacy of this form of analgesia. N 2 O has a low solubility in blood and is not bound to blood proteins. It acts rapidly and is quickly reversible after inhalation is discontinued. A search of the literature identified 12 randomized controlled trials investigating the use of 50% N 2 O (compared with placebo or conventional analgesic regimens) in a range of conditions.

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

Cited by 38 publications

References 18 publications

A Comparison between the Analgesic - Sedative Effects of Ketamine and Nitrous Oxide in Bones’ Fracture Pain Control: A Randomized Clinical Trial

A Comparison between the Analgesic - Sedative Effects of Ketamine and Nitrous Oxide in Bones’ Fracture Pain Control: A Randomized Clinical Trial

Intra-articular lidocaine versus intravenous sedative and analgesic for reduction of anterior shoulder dislocation

Nitrous Oxide for Early Analgesia in the Emergency Setting: A Randomized, Double‐blind Multicenter Prehospital Trial

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