Original contribution
Nitrous oxide analgesia in a pediatric emergency department

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Nitrous oxide (N2O) has been shown to be an effective analgesic in adult medical outpatients, yet no prospective studies of its use in the pediatric medical outpatient exist. Thirty-four children requiring laceration repair were randomly assigned to one of two treatment groups: 30% N2O/70% O2 or a placebo, 100% O2. Pain behavior, using the observer-scored Children's Hospital of Eastern Ontario Pain Scale, was assessed by double-blind techniques, before and during the laceration repair. Less pain behavior was seen in children less than 8 years old who received the N2O mixture than in those receiving the placebo. In patients 8 or more years old who received N2O, there was a significant improvement in the second evaluation as compared with those receiving only O2 during the procedure (P < .05). There also was a smaller increase in pain behavior, from the first to the second evaluation, in those receiving N2O (P < .05). No side effects were encountered. The authors conclude that continuous N2O inhalation is an effective and painless analgesic in children for outpatient procedures. More effective analgesia will likely occur with 40% to 50% N2O, although these concentrations remain to be studied in pediatric outpatients.

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    Presented in part to the Section of Emergency Medicine, American Academy of Pediatrics 56th Annual Meeting in New Orleans, Louisiana, November 1987.

    The Quantiflex MDM Electronic Nitrous Oxide Inhalation machine was provided by Ohmeda Emergency Care, Orchard Park, New York.

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