Nitrous Oxide for Pain Management during in-office Hysteroscopic Sterilization: A Randomized Controlled Trial

Abstract Objectives To evaluate whether inhaled nitrous oxide with oxygen (N2 O/O2 ) is associated with less pain compared to oral sedation for pain management during in-office hysteroscopic sterilization. Study Design This double blinded randomized controlled trial enrolled women undergoing in-offi...

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Bibliographic Details
Published in:Contraception (Stoneham) 2017-03, Vol.95 (3), p.239-244
Main Authors: Schneider, Emily N., MD MS, Riley, Regan, DO MPH, Espey, Eve, MD MPH, Mishra, Shiraz I., MBBS PhD, Singh, Rameet H., MD MPH
Format: Article
Language:English
Subjects:
Adult
Anesthetics, Inhalation - therapeutic use
Double-Blind Method
Female
Humans
Hysteroscopic sterilization
Hysteroscopy
New Mexico
Nitrous oxide
Nitrous Oxide - therapeutic use
Obstetrics and Gynecology
Outpatient Clinics, Hospital
Pain
Pain Management - methods
Pain Measurement
Pregnancy
Sedation
Sterilization, Reproductive
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Summary:Abstract Objectives To evaluate whether inhaled nitrous oxide with oxygen (N2 O/O2 ) is associated with less pain compared to oral sedation for pain management during in-office hysteroscopic sterilization. Study Design This double blinded randomized controlled trial enrolled women undergoing in-office hysteroscopic sterilization. All participants received pre-procedure intramuscular ketorolac and a standardized paracervical block. The intervention group also received N2 O/O2 via a nasal mask titrated to a maximum 70%:30% mixture by a nurse during the procedure and placebo pills pre-procedure and the active control group received inhaled O2 during the procedure and 5/325 mg hydrocodone/acetaminophen and 1 mg lorazepam pre-procedure. The primary outcome was maximum procedure pain on a 100 mm Visual Analogue Scale (VAS with anchors at 0 = no pain and 100 = worst imaginable pain) assessed 3–5 minutes post procedure. Thirty women per treatment arm were required to detect a clinically significant pain difference of 20 mm. Results 72 women, 36 per study arm, were randomized. Mean age of participants was 34.1±5.7 years and mean BMI was 30.1±6.6 kg/m2 . Mean maximum procedure pain scores were 22.8±27.6 mm and 54.5±32.7 mm for intervention and control groups, respectively (p
ISSN:0010-7824
1879-0518
DOI:10.1016/j.contraception.2016.09.006