Fixed 50:50 mixture of nitrous oxide and oxygen to reduce lumbar-puncture-induced pain: a randomized controlled trial.
BACKGROUND AND PURPOSE
Lumbar puncture (LP) has been frequently performed for more than a century. This procedure is still stressful and often painful. The aim of the study was to evaluate the efficacy of a fixed 50% nitrous oxide-oxygen mixture compared to placebo to reduce immediate procedural pain and anxiety during LP.


METHODS
A randomized controlled trial was conducted involving adults who needed a cerebrospinal fluid analysis. Patients were randomly assigned to inhale either a fixed 50% nitrous oxide-oxygen mixture (50% N2 O-O2 ) or medical air (22% O2 -78% N2 ). Cutaneous application of a eutectic mixture of local anaesthetics was systematically done and all LPs were performed with pencil point 25G needles (20G introducer needle). The primary end-point was the maximal pain level felt by the patient during the procedure, the maximal anxiety level being a secondary outcome, both measured using a numerical rating scale (0-10).


RESULTS
A total of 66 consecutive patients were randomized. The analysis was intention to treat. The maximal pain was 4.9 ± 2.7 for the 33 patients receiving air and 2.7 ± 2.7 for the 33 receiving 50% N2 O-O2 (P = 0.002). Similarly, the maximal LP-induced anxiety was 4.5 ± 3.1 vs. 2.6 ± 2.6 (P = 0.009), respectively. The number needed to treat to avoid one patient undergoing significant pain (pain score ≥ 4/10) was 2.75. Body mass index >25 kg/m2 was significantly associated with higher pain intensity (P = 0.03). No serious adverse events were attributable to 50% N2 O-O2 inhalation.


CONCLUSIONS
Inhalation of a fixed 50% N2 O-O2 mixture is efficient to reduce LP-induced pain and anxiety.
['Moisset|X|X|', 'Sia|M A|MA|', 'Pereira|B|B|', 'Taithe|F|F|', 'Dumont|E|E|', 'Bernard|L|L|', 'Clavelou|P|P|']
D000328:Adult D000769:Anesthesia, Inhalation D001007:Anxiety D015992:Body Mass Index D004311:Double-Blind Method D005260:Female D006801:Humans D008297:Male D008875:Middle Aged D009339:Needles D009609:Nitrous Oxide D010100:Oxygen D010146:Pain D010147:Pain Measurement D013129:Spinal Puncture D016896:Treatment Outcome
nitrous oxide pain lumbar puncture procedural pain anxiety