Nitrous Oxide sedation for intra-articular injection in juvenile idiopathic arthritis

Yosef Uziel¹ , Gil Chapnick¹ , Michal Rothschild¹ , Tsivia Tauber² , Joseph Press³ , Liora Harel⁴ and Philip J Hashkes⁵

¹Divisions of Rheumatology, Department of Pediatrics, Meir Medical Center, Kfar Saba, Tel Aviv University, Israel

²Divisions of Rheumatology, Department of Pediatrics, Asaf-Harofe Medical Center, Tsrifin; Tel Aviv University, Israel

³Divisions of Rheumatology, Department of Pediatrics, Soroka University Medical Center, Beer-Sheva; Israel

⁴Divisions of Rheumatology, Department of Pediatrics, Schneider Medical Center, Petah- Tikva, Tel Aviv University, Israel

⁵Section of Pediatric Rheumatology, Department of Rheumatic Diseases, Cleveland Clinic, USA

author email corresponding author email

Pediatric Rheumatology 2008, 6:1doi:10.1186/1546-0096-6-1


Published:	15 January 2008

Abstract

Background

Intra-articular corticosteroid injection in juvenile idiopathic arthritis (JIA) is often associated with anxiety and pain. Recent reports advocate the use of nitrous oxide (NO), a volatile gas with analgesic, anxiolytic and sedative properties.

Objective

To prospectively evaluate the effectiveness and safety of NO analgesia for intra-articular corticosteroid injection in JIA, and to assess patients and staff satisfaction with the treatment.

Methods

NO was administered to JIA patients scheduled for joint injection. The patient, parent, physician and nurse completed visual-analog scores (VAS) (0–10) for pain, and a 5-point satisfaction scale. Change in heart rate (HR) during the procedure was recorded in order to examine physiologic response to pain and stress. Patient's behavior and adverse reactions were recorded.

Results

54 procedures (72 joints) were performed, 41 females, 13 males; 39 Jewish, 13 Arab; mean age was 12.2 ± 4.7 year. The median VAS pain score for patients, parents, physicians and nurses was 3. The HR increased ≥ 15% in 10 patients. They had higher VAS scores as evaluated by the staff. The median satisfaction level of the parents and staff was 3.0 and 5.0 respectively. Adverse reactions were mild.

Conclusion

NO provides effective and safe sedation for JIA children undergoing intra-articular injections.