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Wang Z, Wang F, Jiang X, Wang W, Xing Y, Qiu X, Sun C, Tang L. Nitrous Oxide to Reduce Wound Care-Related Pain in Adults: A Systematic Review and Meta-Analysis. Adv Wound Care (New Rochelle) 2024. [PMID: 38511513 DOI: 10.1089/wound.2023.0211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2024] Open
Abstract
Significance: As an essential procedure, wound care comes with acute pain, which is short but high in intensity, causing patients to fear and affecting subsequent treatment. Nitrous oxide (N2O) is used to relieve pain related to wound care; however, evidence regarding its application is conflicting. Thus, this systematic review and meta-analysis was performed to evaluate the efficacy of N2O in wound care-related pain. Recent Advances: Randomized controlled trials that investigated the effect of N2O in adults undergoing wound care were systematically searched from PubMed, Embase, the Cochrane Library, Web of Science, Scopus, and ClinicalTrials.gov up to February 2023. The primary outcome was the pain score. Secondary outcomes included patients' satisfaction and side effects. Critical Issues: Through screening the 265 identified articles, seven and six studies were finally included in the systematic review and meta-analysis, respectively. Pooled analysis suggested that there was no significant difference in reducing wound care-related pain between the N2O group and the control group (mean difference [MD], -0.02, 95% confidence interval [CI], -1.46, 1.42; p = 0.98, I2 = 96%). Subgroup analyses indicated that there was a significant difference in favor of N2O for burns, not for ulcers, and N2O was superior to oxygen and similar to topical or intravenous anesthesia. There was no significant difference in patients' satisfaction or the incidence of side effects between groups. Future Directions: This review suggests that N2O might be effective for pain management in patients undergoing wound care. Caution must be taken when interpreting these results due to the high risk of biased methods in the included studies.
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Affiliation(s)
- Ziyang Wang
- Department of Stomatology, The 960th Hospital of People' s Liberation Army of China (PLA), Jinan, People's Republic of China
- School of Nursing, Weifang Medical University, Weifang, People's Republic of China
| | - Fei Wang
- Department of Anesthesiology, The 960th Hospital of People's Liberation Army of China (PLA), Jinan, People's Republic of China
| | - Xiaochen Jiang
- Department of Stomatology, The 960th Hospital of People' s Liberation Army of China (PLA), Jinan, People's Republic of China
- School of Nursing, Weifang Medical University, Weifang, People's Republic of China
| | - Weifeng Wang
- Department of Stomatology, The 960th Hospital of People' s Liberation Army of China (PLA), Jinan, People's Republic of China
- School of Nursing, Weifang Medical University, Weifang, People's Republic of China
| | - Yihui Xing
- Department of Stomatology, The 960th Hospital of People' s Liberation Army of China (PLA), Jinan, People's Republic of China
- School of Nursing, Weifang Medical University, Weifang, People's Republic of China
| | - Xueling Qiu
- Department of Stomatology, The 960th Hospital of People' s Liberation Army of China (PLA), Jinan, People's Republic of China
- School of Nursing, Shandong First Medical University, Tai'an, People's Republic of China
| | - Chenxi Sun
- Department of Stomatology, The 960th Hospital of People' s Liberation Army of China (PLA), Jinan, People's Republic of China
- Graduate Training Base of Jinzhou Medical University, The 960th Hospital of People's Liberation Army of China, Jinzhou, People's Republic of China
| | - Lu Tang
- Department of Stomatology, The 960th Hospital of People' s Liberation Army of China (PLA), Jinan, People's Republic of China
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Xing Y, Zhou L, Yu J, Wang Z, Ding Z, Xie C, Li Y, Wang F, Tang L. Analgesic efficacy of nitrous oxide in adults in the emergency department: A meta-analysis of randomized controlled trials. Am J Emerg Med 2022; 56:92-99. [DOI: 10.1016/j.ajem.2022.03.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Revised: 03/06/2022] [Accepted: 03/13/2022] [Indexed: 11/24/2022] Open
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Fowler KG, Byraiah G, Burt C, Lee DB, Miller RJ. Nitrous Oxide Use for Intrauterine System Placement in Adolescents. J Pediatr Adolesc Gynecol 2022; 35:159-164. [PMID: 34748915 DOI: 10.1016/j.jpag.2021.10.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 10/06/2021] [Accepted: 10/25/2021] [Indexed: 10/19/2022]
Abstract
STUDY OBJECTIVE To evaluate the impact of nitrous oxide on patient-reported pain for placement of intrauterine systems (IUSs) in adolescents STUDY DESIGN: : Prospective observational study SETTING: : IUS placement in an ambulatory clinic compared with placement with nitrous oxide in a hospital-based sedation unit PARTICIPANTS: : English-speaking adolescents aged 12 to 20 presenting to a pediatric and adolescent gynecologist with a medical indication for IUS placement MAIN OUTCOME MEASURES: : Patient-reported procedural pain measured on a visual analog scale 2 minutes post IUS insertion procedure. Secondary outcome measurement of likelihood of recommending an IUS to a peer. RESULTS Seventy-four patients agreed to participate. Forty-five patients underwent IUS placement in the clinic. Controlling for age, history of dysmenorrhea, and body mass index, a significant time (change in reported pain scores pre- vs post IUS insertion) by treatment (nitrous oxide vs standard of care) interaction was observed for patient-reported pain (b = -29.32 mm, P < 0.01). Patients receiving nitrous oxide were more likely to recommend an intrauterine placement than patients who received the current standard of care for pain management (b = 0.47, P = 0.02) after controlling for age, baseline pain score, and dysmenorrhea history. CONCLUSION Patient-reported pain was attenuated for patients who received nitrous oxide relative to those who received standard IUS placement. Patient-reported satisfaction was higher for patients who received nitrous oxide relative to those who received standard IUS placement.
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Affiliation(s)
| | | | | | - Daniel B Lee
- Amherst H. Wilder Foundation, St. Paul, Minnesota
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Chumpitazi CE, Chang C, Atanelov Z, Dietrich AM, Lam SH, Rose E, Ruttan T, Shahid S, Stoner MJ, Sulton C, Saidinejad M. Managing acute pain in children presenting to the emergency department without opioids. J Am Coll Emerg Physicians Open 2022; 3:e12664. [PMID: 35310402 PMCID: PMC8918119 DOI: 10.1002/emp2.12664] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 12/12/2021] [Accepted: 01/03/2022] [Indexed: 02/06/2023] Open
Abstract
Pediatric pain is challenging to assess and manage. Frequently underestimated in children, untreated pain may have consequences including increased fear, anxiety, and psychological issues. With the current opioid crisis, emergency physicians must be knowledgeable in both pharmacologic and non‐pharmacologic approaches to address pain and anxiety in children that lead to enhanced patient cooperation and family satisfaction. This document focuses pain management and distress mitigation strategies for the brief diagnostic and therapeutic procedures commonly performed.
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Affiliation(s)
- Corrie E. Chumpitazi
- Department of Pediatrics Division of Emergency Medicine, Baylor College of Medicine, Texas Children's Hospital Houston Texas USA
| | - Cindy Chang
- Department of Pediatrics, Division of Emergency Medicine Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine Cincinnati Ohio USA
| | - Zaza Atanelov
- North Florida Regional Medical Center Emergency Department HCA/University of Central Florida College of Medicine Consortium Florida USA
| | - Ann M. Dietrich
- Department of Pediatrics and Emergency Medicine University of South Carolina College of Medicine Greenville North Carolina USA
| | - Samuel Hiu‐Fung Lam
- Department of Emergency Medicine Sutter Medical Center Sacramento Sacramento California USA
| | - Emily Rose
- Keck School of Medicine of the University of Southern California Los Angeles California USA
| | - Tim Ruttan
- Dell Children's Medical Center, Department of Pediatrics The University of Texas at Austin Dell Medical School, US Acute Care Solutions Austin Texas USA
| | - Sam Shahid
- American College of Emergency Physicians Irving Texas USA
| | - Michael J. Stoner
- Nationwide Children's Hospital The Ohio State University College of Medicine Columbus Ohio USA
| | - Carmen Sulton
- Emory University School of Medicine Children's Healthcare of Atlanta Atlanta Georgia USA
| | - Mohsen Saidinejad
- Department of Emergency Medicine Harbor UCLA Medical Center Torrance California USA
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