Nitrous oxide for pain management during in-office hysteroscopic sterilization: a randomized controlled trial

作者：Schneider Emily N; Riley Regan; Espey Eve; Mishra Shiraz I; Singh Rameet H^*

来源：Contraception, 2017, 95(3): 239-244.

DOI：10.1016/j.contraception.2016.09.006

• Nitrous oxide
• Pain
• Hysteroscopic sterilization
• Sedation

Objectives: To evaluate whether inhaled nitrous oxide with oxygen (N2O/O-2) 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 N2O/O-2\ 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 02 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 Analog Scale (VAS with anchors at 0 = no pain and 100 = worst imaginable pain) assessed 3-5 min post procedure. Thirty women per treatment arm were required to detect a clinically significant pain difference of 20 mm.
Results: Seventy-two 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/m(2). Mean maximum procedure pain scores were 22.8 +/- 27.6 mm and 54.5 +/- 32.7 mm for intervention and control groups, respectively (p<.001). Most study participants (97%) stated N2O/O-2 should be offered for gynecologic office procedures and 86% would pay for it if not a covered benefit.
Conclusions: N2O/O-2 decreased pain with in-office hysteroscopic sterilization compared to oral sedation and is an effective pain management option for this procedure.

• 出版日期2017-3