Paramedic CAT (Critically Appraised Topic)
002 | Nitrous oxide for early analgesia in the prehospital Setting
|
Author |
Jennie Helmer |
Date |
2020-09-02 |
|
Reviewer |
- |
Edited |
2020-10-22 |
Case Study
You respond to a 39 yof who is complaining of moderate to severe foot pain, after getting kicked during a soccer game. As you approach the patient, you note that she is in visible pain and crying out in pain whenever she tries to move her foot. You expose her injury and note a significant deformity with swelling and bruising above the right lateral malleolus. You support her in the position of comfort, offer her Nitrous Oxide (Entonox) and prepare to splint the ankle.
What should you know about Entonox, and what can you tell your patient about the benefits of using this gas?
PICO Question
“In pre-hospital patients experiencing moderate to severe pain, does Nitrous Oxide (Entonox) versus no analgesia, or other analgesia, offer pain relief?”
|
Population |
Adult patient with moderate pain in the prehospital setting |
|
Intervention |
Nitrous Oxide (Entonox) |
|
Comparison |
No analgesia |
|
Outcome |
Pain relief |
Search Strategy
Pubmed & Google Scholar: (Prehospital Patients in pain OR out-of-hospital Patients in pain) AND (“Entonox” OR “Nitrous Oxide” OR “Laughing Gas”) AND (“No Analgesia” OR “No Narcotics” OR “Oxygen”) AND (“Pain Relief” OR “Analgesia”)
Search Outcome
10 Results (5 Relevant) on 2020-09-02
Clinical Bottom Line
These papers provide supportive evidence for the use of the Nitrous Oxide for the safe and effective treatment of pain, with a low incidence of significant adverse events, from acute trauma in the prehospital setting. One study (Kariman, 2011) in particular, compared the effectiveness of Nitrous Oxide with Fentanyl, and found neither to be superior.
Relevant Results
- Ducassé JL, Siksik G, Durand-Béchu M, et al. Nitrous oxide for early analgesia in the emergency setting: a randomized, double-blind multicenter prehospital trial. 2013. [LINK]
- Faddy SC, Garlick SR. A systematic review of the safety of analgesia with 50% nitrous oxide: can lay responders use analgesic gases in the prehospital setting? 2005. [LINK]
- Kariman H, Majidi A, Amini A, et al. Nitrous oxide/oxygen compared with fentanyl in reducing pain among adults with isolated extremity trauma: a randomized trial. 2011. [LINK]
- McKinnon KD. Prehospital analgesia with nitrous oxide/oxygen. 1981. [LINK]
- Stewart RD. Nitrous oxide sedation/analgesia in emergency medicine. 1985. [LINK]