title: The use of inhaled nitrous oxide for analgesia in adult ED patients: a pilot study.
abstract: BACKGROUND
  Oligoanalgesia challenges emergency department (ED) health care providers and remains an area of patient dissatisfaction. Nitrous oxide (NO) is a safe, quick-acting, and well-tolerated sedative agent with analgesic and anxiolytic properties that make it ideal for ED use.
  
  
  OBJECTIVE
  We seek to test the effectiveness of a self-administered and self-contained NO device as an analgesic agent in the ED and assess patient and staff satisfaction with this method.
  
  
  METHODS
  We enrolled 85 patients 18 years and older in a prospective observational study of patients presenting to the ED with moderate to severe pain (≥30 mm on a 100-mm visual analog scale). Subjects received a mixture of 50% NO via a self-administered portable delivery device. Primary outcome was the reduction in baseline pain scores at 20, 40, and 60 minutes. Secondary outcomes were patient, nurse, and physician satisfaction as reported on a brief satisfaction questionnaire.
  
  
  RESULTS
  There was a significant reduction in mean pain scores from baseline to 20 minutes that was sustained through the 60-minute period. Most subjects (93%; 95% confidence interval [CI], 85%-97%) and nurses (97%; 95% CI, 90%-99%) reported that the NO delivery system was easy to use and were satisfied with the level of pain relief and would use NO in the future (82%; 95% CI, 73%-89%). Physicians and nurses were also satisfied with the analgesic effects of NO (82%; 95% CI, 73%-89%).
  
  
  CONCLUSIONS
  The portable NO device is an effective analgesia adjunct for ED patients presenting with painful conditions, and patients, ED nurses, and emergency physicians are satisfied with its use. Nitrous oxide coupled with a nurse-driven analgesia protocol may provide a novel solution for improvement in ED analgesia rates and overall patient satisfaction with ED pain management.
authors.affiliation: Albert Einstein Medical Center, Philadelphia, PA. Electronic address: herresjo@einstein.edu.
authors.forename: Joseph
authors.initials: J
authors.lastname: Herres
authors.affiliation: Albert Einstein Medical Center, Philadelphia, PA; Department of Emergency Medicine Keck School of Medicine of USC1200 North State Street, Room 1011 Los Angeles, CA 90033-1029.
authors.forename: Carl R
authors.initials: CR
authors.lastname: Chudnofsky
authors.affiliation: Albert Einstein Medical Center, Philadelphia, PA.
authors.forename: Rashmi
authors.initials: R
authors.lastname: Manur
authors.affiliation: Albert Einstein Medical Center, Philadelphia, PA.
authors.forename: Kathia
authors.initials: K
authors.lastname: Damiron
authors.affiliation: Albert Einstein Medical Center, Philadelphia, PA.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Deitch
mesh_terms: D000280:Administration, Inhalation; D000328:Adult; D018685:Anesthetics, Inhalation / Q000009:adverse effects / Q000627:therapeutic use*; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D009609:Nitrous Oxide / Q000009:adverse effects / Q000627:therapeutic use*; D059408:Pain Management / Q000379:methods*; D010147:Pain Measurement; D017060:Patient Satisfaction; D010865:Pilot Projects; D011446:Prospective Studies; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
chemical_list: D018685:Anesthetics, Inhalation; D009609:Nitrous Oxide