AcutePain(2003) 5,25—30 Continuous flow 50:50 nitrous oxide:oxygen is effective for relief of procedural pain in the pediatric emergency department Ilan Keidan a,b , Ruth Zaslansky a , Yakov Yusim a , Michael Ben-Ackon c , Marina Rubinstien c , Azriel Perel a , Arie Augarten c, * a Unit of Pediatric Anesthesia, Chaim Sheba Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel Hashomer, 52621 Tel-Aviv, Israel b Departments of Anesthesia and Intensive Care, Chaim Sheba Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel Hashomer, 52621 Tel-Aviv, Israel c Department of Pediatric Emergency Care, Chaim Sheba Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel Hashomer, 52621 Tel-Aviv, Israel Received 21 October 2002; received in revised form 1 April 2003; accepted 12 May 2003 KEYWORDS Child; Procedural pain; Nitrous oxide; Emergency department; Side effects Summary Objectives:Todetermineapplicabilityofcontinuousflow50:50N 2 O:oxygen during painful procedures in our university-hospital pediatric emergency department (ED). Methods: Children scheduled to undergo a painful procedure were enrolled consecutively. 50:50 N 2 O:oxygen was provided throughout the procedure. Pain was evaluatedusinganumericalpainscale(0:nopainto10:unbearablepain)bychildren ≥6 years old, medical providers and parent. Duration of N 2 O inhalation, recovery time, side effects, provision and type of supplementary analgesics were recorded. Results: Fifty-nine children, 0.5—15 years enrolled and 55 comprised the final study cohort. Pain scores, as reported by the different observers, were low. N 2 O adminis- tration was more beneficial in children >3 versus <3. Under N 2 O, pain during infil- tration of the skin with lidocaine was higher than during suturing. Children returned to pre-inhalation behavior by a mean of 2.7 ± 1.6min. Vomiting, the most common side effect, occurred in five (9.0%) children. All parents reported that they would be willing for their child to use N 2 O again, if necessary. Conclusions: Continuous flow 50:50 N 2 O:oxygen is effective for procedural pain in the pediatric ED. It is agreeable to children, particularly >3 years old, medical providers and parents, provides short recovery times and bears minor adverse effects. © 2003 Elsevier B.V. All rights reserved. 1. Introduction The goals of analgesia and sedation in the emer- gency department (ED) are to minimize or to elim- *Corresponding author. Tel.: +972-3-5303054; fax: +972-3-5302945. E-mail address: augarten@post.tau.ac.il (A. Augarten). inate procedure-related pain. In practice, manage- mentofthistypeofpain,stillposesaproblem [1], particularly in pediatric patients [2]. N 2 O provides sedation, analgesia, amnesia and dissociation, making patients’ recall of an event as more pleasant than it actually was [1]. The mech- anism for the analgesia is unknown, but it appears to act on the central nervous system by activat- ing opiate and sympathetic supra-spinal and spinal 1366-0071/$ – see front matter © 2003 Elsevier B.V. All rights reserved. doi:10.1016/S1366-0071(03)00026-3