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Nitrous oxide analgesia during intra-articular injection for juvenile idiopathic arthritis
  1. A G Cleary1,
  2. A V Ramanan2,
  3. E Baildam2,
  4. A Birch1,
  5. J A Sills1,
  6. J E Davidson1
  1. 1Department of Paediatric Rheumatology, Royal Liverpool Children's Hospital, UK
  2. 2Department of Paediatric Rheumatology, Royal Manchester Children's Hospital, UK
  1. Correspondence to:
    Dr A G Cleary, Department of Paediatric Rheumatology, Royal Liverpool Children's Hospital, UK;


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.

  • juvenile idiopathic arthritis
  • nitrous oxide
  • pain assessment
  • JIA, juvenile idiopathic arthritis
  • PIP, proximal interphalangeal
  • VAS, visual analogue scale

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