ORIGINAL ARTICLE

Nitrous oxide analgesia during intra-articular injection for juvenile idiopathic arthritis

A G Cleary¹, A V Ramanan², E Baildam², A Birch¹, J A Sills¹, J E Davidson¹

¹ Department of Paediatric Rheumatology, Royal Liverpool Children's Hospital, UK
² Department of Paediatric Rheumatology, Royal Manchester Children's Hospital, UK

Correspondence to:
Correspondence to:
Dr A G Cleary, Department of Paediatric Rheumatology, Royal Liverpool Children's Hospital, UK;
gavin.cleary{at}talk21.com

Aims: To evaluate the efficacy and safety of nitrous oxide–oxygen for children with juvenile idiopathic arthritis (JIA) undergoing intra-articular corticosteroid injection.

Methods: A total of 55 consecutive patients with JIA undergoing intra-articular corticosteroid injection, using self administered nitrous oxide–oxygen for analgesia were studied. Patient, nurse, and parent pain scores were compared using a 0–10 cm visual analogue scale (VAS) immediately after the procedure.

Results: A total of 70 joints were injected in 55 patients (median age 13.54 years). The median pain score for patient, nurse, and parent was 1 (0–10 cm VAS). The mean rank patient score was 2.12, which was greater than the nurse score (1.97), which was greater than the parent score (1.91). These differences were significant. There were no serious adverse events in any patient.

Conclusions: Nitrous oxide–oxygen provides safe and effective analgesia for intra-articular injection in children. In some cases, nurses and parents underestimated pain related to the procedure compared to the child.

Keywords: juvenile idiopathic arthritis; nitrous oxide; pain assessment

Abbreviations: JIA, juvenile idiopathic arthritis; PIP, proximal interphalangeal; VAS, visual analogue scale

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

This article has been cited by other articles:

• Beresford, M W, Baildam, E M (2009). New advances in the management of juvenile idiopathic arthritis--1: Non-biological therapy. EDUCATION AND PRACTICE 94: 144-150 [Abstract] [Full Text]  
• Zier, J. L., Drake, G. J., McCormick, P. C., Clinch, K. M., Cornfield, D. N. (2007). Case-Series of Nurse-Administered Nitrous Oxide for Urinary Catheterization in Children. Anesth. Analg. 104: 876-879 [Abstract] [Full Text]  
• Ekbom, K, Jakobsson, J, Marcus, C (2005). Nitrous oxide inhalation is a safe and effective way to facilitate procedures in paediatric outpatient departments. Arch. Dis. Child. 90: 1073-1076 [Abstract] [Full Text]  
• Frampton, A, Browne, G J, Lam, L T, Cooper, M G, Lane, L G (2003). Nurse administered relative analgesia using high concentration nitrous oxide to facilitate minor procedures in children in an emergency department. Emerg. Med. J. 20: 410-413 [Abstract] [Full Text]  
• Ishikawa, M., Quock, R. M. (2003). Role of Nitric-Oxide Synthase Isoforms in Nitrous Oxide Antinociception in Mice. J. Pharmacol. Exp. Ther. 306: 484-489 [Abstract] [Full Text]  
• Cleary, A G, Murphy, H D, Davidson, J E (2003). Intra-articular corticosteroid injections in juvenile idiopathic arthritis. Arch. Dis. Child. 88: 192-196 [Abstract] [Full Text]