Continuous flow 50:50 nitrous oxide:oxygen is effective for relief of procedural pain in the pediatric emergency department

Ilan Keidan, Ruth Zaslansky, Yakov Yusim, Michael Ben-Ackon, Marina Rubinstien, Azriel Perel, Arie Augarten*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

10 Scopus citations


Objectives: To determine applicability of continuous flow 50:50 N2O: 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 N2O: oxygen was provided throughout the procedure. Pain was evaluated using a numerical pain scale (0: no pain to 10: unbearable pain) by children ≥6 years old, medical providers and parent. Duration of N2O 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. N2O administration was more beneficial in children >3 versus <3. Under N2O, pain during infiltration of the skin with lidocaine was higher than during suturing. Children returned to pre-inhalation behavior by a mean of 2.7 ± 1.6 min. 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 N2O again, if necessary. Conclusions: Continuous flow 50:50 N2O: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.

Original languageEnglish
Pages (from-to)25-30
Number of pages6
JournalAcute Pain
Issue number1
StatePublished - 2003


  • Child
  • Emergency department
  • Nitrous oxide
  • Procedural pain
  • Side effects


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