Nitrous oxide provides safe and effective analgesia for minor paediatric procedures: a systematic review

Introduction: Pain and distress during minor hospital-related procedures is a familiar problem in many children. Inadequate relief of children's procedural pain and distress not only affects the experience of the children and their parents, but also adversely impacts procedural success. We aimed to review the safety and efficacy of nitrous oxide during brief, but painful paediatric procedures and to compare nitrous oxide with some of the commonly used pharmacological and non-pharmacological treatments for relieving anxiety and mild to moderate pain in Denmark.

Method: We searched MEDLINE (PubMed) and the Cochrane Database of Systematic Reviews with the MeSH term nitrous oxide combined with midazolam, surgical procedures minor, analgesia or conscious sedation. The references in the articles acquired that were not found in the MEDLINE search were further investigated. Only articles written in English and published after 1980 were included to ensure optimal data collection.

Results: Nitrous oxide is an effective sedative/analgesic for mildly to moderately painful paediatric procedures. Furthermore, it is safely administrated, particularly for short procedures (< 15 min.). Serious and potentially serious adverse events are rare and occur in less than 0.5% of cases, while minor events typically occur amongst 4-8% of patients.

Conclusion: Nitrous oxide is a safe and effective method to achieve analgesia and sedation during minor, but painful procedures. It can be safely administered by a dedicated staff member. This helpful method is still underused in Denmark, and we believe that it could be an alternative or the first choice of treatment in emergency and paediatric departments.