title: Does nitrous oxide labor analgesia influence the pattern of neuraxial analgesia usage? An impact study at an academic medical center.
abstract: OBJECTIVE
  To compare the rate of epidural use before and after the implementation of nitrous oxide (N2O).
  
  
  METHODS
  Data were obtained from a nursing database of N2O usage and our obstetric anesthesia database. We compared 8 months before and 8 months after the introduction of N2O. It was available 24 h/d, 7 d/wk, consistent with neuraxial analgesia availability. Epidural utilization before and after introduction of N2O was compared using χ2analysis.
  
  
  METHODS
  Labor and delivery floor.
  
  
  RESULTS
  Total number of births over the study period was 8539: 4315 pre-N2O and 4224 post-N2O. The rate of epidural usage was 77% pre-N2O and 74% after N2O (P= not significant, χ2). A total of 762 patients used N2O. Monthly analysis showed no change in pattern of neuraxial analgesia use in post-N2O period compared with the pre-N2O period.
  
  
  CONCLUSIONS
  The introduction of N2O for labor analgesia was not associated with any change in our rate of labor epidural utilization. Under the conditions of our study, these results suggest that N2O does not discourage neuraxial use for labor pain relief.
authors.affiliation: Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115. Electronic address: lbobb@partners.org.
authors.forename: Lesley E
authors.initials: LE
authors.lastname: Bobb
authors.affiliation: Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115. Electronic address: mkfarber@partners.org.
authors.forename: Michaela K
authors.initials: MK
authors.lastname: Farber
authors.affiliation: Center for Labor and Birth, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115. Electronic address: cmcgovern2@partners.org.
authors.forename: Catherine
authors.initials: C
authors.lastname: McGovern
authors.affiliation: Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115. Electronic address: wcamann@partners.org.
authors.forename: William
authors.initials: W
authors.lastname: Camann
mesh_terms: D000046:Academic Medical Centers / Q000706:statistics & numerical data; D015360:Analgesia, Epidural / Q000706:statistics & numerical data*; D016362:Analgesia, Obstetrical / Q000379:methods* / Q000706:statistics & numerical data; D018712:Analgesics, Non-Narcotic / Q000008:administration & dosage*; D000701:Analgesics, Opioid / Q000008:administration & dosage; D000779:Anesthetics, Local / Q000008:administration & dosage; D002045:Bupivacaine / Q000008:administration & dosage; D002585:Cesarean Section / Q000706:statistics & numerical data; D036861:Delivery, Obstetric / Q000009:adverse effects; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage; D006801:Humans; D009609:Nitrous Oxide / Q000008:administration & dosage*; D059408:Pain Management / Q000379:methods*; D011247:Pregnancy; D062606:Tertiary Care Centers / Q000706:statistics & numerical data
chemical_list: D018712:Analgesics, Non-Narcotic; D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D009609:Nitrous Oxide; D005283:Fentanyl; D002045:Bupivacaine
keywords: Neuraxial analgesia; Nitrous oxide