Safety and Risks of Nitrous Oxide Labor Analgesia: A Review

Rooks, Judith P.

doi:10.1111/j.1542-2011.2011.00122.x

Cited by 66 publications

(48 citation statements)

References 60 publications

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“…Use of nitrous oxide during labor began in the late 1800s, and Minnitt in England introduced equipment for self-administration in 1934. Nitrous oxide is usually run through a mouth mask intermittently, starting about 30 seconds before each contraction (7, 8). Inhalation of 50% nitrous oxide can significantly decrease anxiety without clinically significant side effects, and its effects are quickly reversible upon discontinuation of inhalation (8, 9).…”

Section: Introductionmentioning

confidence: 99%

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A Randomized Controlled Trial Comparing Use of Enthonox With Pethidine for Pain Relief in Primigravid Women During the Active Phase of Labor

et al. 2016

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BackgroundThe use of pain-relieving drugs during labor is now part of standard care in many countries throughout the world. Each method of pain relief has its own risks and benefits, variations in effectiveness, and availability and acceptability.ObjectivesThis study aimed to assess the efficacy and safety of intramuscular pethidine as an analgesic during labor by comparing it to inhaled 50% nitrous oxide (Entonox).MethodsIn this clinical trial study, 100 women who expected to have a natural childbirth were observed. The inclusion criteria for this study were the commencement of spontaneous labor pain along with appropriate maternal and fetal indications for vaginal delivery. By using random numbers, each subject was randomly allocated to one of two groups, with one group using Entonox and the other receiving an intramuscular injection of 0.5 mg/kg of pethidine for pain relief. The intensity of labor pain experienced by the subjects and the outcomes of the deliveries were collected with questionnaires.ResultsThe average pain scores in the Entonox and pethidine groups were 3.94 ± 1.4 and 5.6 ± 1.1, respectively, 30 minutes after intervention (P = 0.001), but there was not a significant difference in the severity of the pain (5.06 ± 1.4 and 4.7 ± 1.1 for the Entonox and pethidine groups, respectively) between the subjects in each group 60 minutes after the intervention (P = 0.592). No significant differences were seen in the duration and interval of uterine contractions, maternal complications, Apgar scores, and the duration of the first and second stage of labor between the two studied groups (P > 0.05). An analysis of the pooled risk differences showed that none of the side effects investigated were significantly different between the two groups except for mouth dryness, which was significantly higher in nitrous oxide users (P = 0.044).ConclusionsInhaled nitrous oxide seems to give better pain relief in the short term compared to a single dose of pethidine. Entonox, which is more convenient to administer than an intramuscular injection of pethidine, is also regarded as safe both for mothers and neonates.

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Section: Introductionmentioning

confidence: 99%

“…However, systemic opioids lead to some complications for mothers (12, 13) and babies (14). Since pethidine passes through the placenta, pethidine may accumulate in the fetal circulation (8), causing early neonatal respiratory depression and behavioral and feeding problems for up to six weeks after delivery (14). …”

Section: Introductionmentioning

confidence: 99%

A Randomized Controlled Trial Comparing Use of Enthonox With Pethidine for Pain Relief in Primigravid Women During the Active Phase of Labor

et al. 2016

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“…maxilla facial fracture, who have received excessive amounts of intravenous opioids or morphine derivatives and/or benzodiapines as sedation may be increased are vitamin B 12 deficient or receiving vitamin B 12 , recent ear surgery, inner ear obstruction, have a compromised fetus, are haemodynamically unstable. [13][14][15] There is the theoretical risk of bone marrow suppression through the inhibition of methionine synthase, as nitrous oxide inactivates co-factor B 12.…”

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The effect of nitrous oxide (entonox) on labour

Naddoni

Balakundi

Assainar

2016

Int J Reprod Contracept Obstet Gynecol

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“…Moreover, N 2 O presents a major advantage of inducing a temporary and reversible hazy memory effect confined to the memories of procedure-related trauma 19,21,29. Moreover, several studies indicate that N 2 O use during labor effectively helps women relax and reduces their perception of pain, even though they may still be aware that pain is present.…”

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confidence: 99%

Managing pain and anxiety during transabdominal chorionic villus sampling. A noninferiority randomized trial of nitrous oxide vs local anesthesia

Katsogiannou

Donato

Loundou

et al. 2018

Acta Obstet Gynecol Scand

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Introduction: Transabdominal chorionic villus sampling (CVS) is an invasive proce-dure for prenatal diagnosis reported to be associated with anxiety and pain. In this context, the need for analgesia during CVS has been considered useful. Even though several authors have been interested in pain management during amniocentesis, no study has been published on pain reduction during CVS. Our objective was to evaluate pain and anxiety management during transabdominal CVS using nitrous oxide (N 2 O) and local anesthesia. Material and methods:In a randomized controlled noninferiority trial, self-administered nitrous oxide (N 2 O) inhalation (equimolar premix of oxygen and nitrous oxide) was compared with local anesthesia (1% lidocaine) before CVS. Primary outcome was pain and secondary outcome was anxiety, both measured on a visual analog scale 30-60 minutes before, immediately after (5-10 minutes) and 30-60 minutes after CVS. With a statistical power of 90%, type I error of 5% and two-sided test and potential exclusions, a sample size of 96 patients per group was enrolled and randomized. No patient was enrolled before the trial registration date.

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Safety and Risks of Nitrous Oxide Labor Analgesia: A Review

Abstract: Nitrous oxide labor analgesia is safe for the mother, fetus, and neonate and can be made safe for caregivers. It is simple to administer, does not interfere with the release and function of endogenous oxytocin, and has no adverse effects on the normal physiology and progress of labor.

Cited by 66 publications

References 60 publications

A Randomized Controlled Trial Comparing Use of Enthonox With Pethidine for Pain Relief in Primigravid Women During the Active Phase of Labor

A Randomized Controlled Trial Comparing Use of Enthonox With Pethidine for Pain Relief in Primigravid Women During the Active Phase of Labor

The effect of nitrous oxide (entonox) on labour

Managing pain and anxiety during transabdominal chorionic villus sampling. A noninferiority randomized trial of nitrous oxide vs local anesthesia

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