Print

Paediatrics

Controlling pain and anxiety in children 

Children sometimes experience short but painful therapeutic and diagnostic procedures without adequate analgesic treatment.

However, it is important to treat procedural pain in children because inadequate pain relief and the distress this causes may have long-lasting effects on future tolerance and response to pain.

A fast-acting, non-invasive technique is particularly advantageous in small children who may or may not be able to rationalise their pain or communicate the level of pain they are experiencing.

No needles 

Nitrous oxide/oxygen mixtures have repeatedly been shown to be an efficacious choice of pain relief for minor painful paediatric procedures (1, 2, 3, 4). Its analgesic properties can help to reduce the pain and discomfort felt by children. The administration of this medical gas requires no needles, stitches or bad tasting medicine.

Nitrous oxide/oxygen mixtures will help alleviate procedural pain in children. This has been examined in relation to lumbar puncture, bone marrow aspiration, laceration repair, venepuncture and repositioning of fractures, among other procedures (5). It is seen as a valuable, if underused, method of pain relief in emergency and other paediatric care where there is an obvious need for a rapid and easy-to-use analgesic that can be safely administered by trained staff. Many children say they would also accept the method in subsequent procedures. (5)

Well documented efficacy 

The efficacy of nitrous oxide/oxygen in paediatric out-patient procedures is well documented (6). The mixture has been shown to be highly effective for reducing the pain and anxiety felt by children (7, 8, 9). Its use has been associated with high satisfaction ratings among children, as well as their parents and medical staff (10).

The properties of nitrous oxide/oxygen mixtures help to relieve apprehension in the child before and during the procedure.

Administration in children 

Nitrous oxide/oxygen mixtures can be used in children who are able to understand and follow instructions on how to use the equipment.

(1) Hennerikus WL et al. Self-administered nitrous oxide analgesia for pediatric fracture reductions. J Pediatr Orthop 1994; 14:538-42.
(2) Manikandan R, Srirangam SJ, Brown SC et al. Nitrous oxide vs periprostatic nerve block with 1% lidocaine during transrectal ultrasound guided biopsy of the prostate: a prospective, randomized, controlled trial. J Urol 2003; 170(5):1881-3.
(3) Saunders BP; Fukumoto M, Halligan S et al. Patient-administered nitrous oxide/oxygen inhalation provides effective sedation and analgesia for colonoscopy. Gastrointest Endosc 1994; 40(4): 418-21.
(4) Lindblom A, Jansson O, Jeppsson B et al. Nitrous oxide for colonoscopy discomfort: a randomized double-blind study. Endoscopy 1994; 26(3): 283-6.
(5) Annequin D, Carbajal R, Chauvin P et al. Fixed 50% Nitrous oxide mixtures for painful procedures: a French survey. Pediatrics 2000; 105(4):47-58.
(6) Ekbom K, Jakobsson J, Marcus C. Nitrous oxide inhalation is a safe and effective way to facilitate procedures in pediatric outpatient departments. Arch Dis Child 2005; 90:1073-6.
(7) Masood J, Shah N, Lane T et al. Nitrous oxide (Entonox) inhalation and tolerance of transrectal ultrasound guided prostate biopsy: a double-blind randomized controlled study. J Urol 2002; 168(1):116-20.
(8) Notini-Gudmarsson AK, Dolk A, Jakobsson J et al. Nitrous oxide: a valuable alternative for pain relief and sedation during routine colonoscopy. Endoscopy 1996; 28(3):283-7.
(9) Atassi K, Mangiapan G, Fuhrman C et al. Prefixed equimolar nitrous oxide and oxygen mixture reduces discomfort during flexible bronchoscopy in adult patients. A randomized, controlled, double-blind trial. CHEST 2004; 125:315-321.
(10) Fauroux B. The efficiacy of premixed nitrous oxide and oxygen  for fiberoptic bronchoscopy in pediatric patients: a randomized, double blind, controlled study. CHEST 2004; 125:315-321.

Up