1
|
Costamagna D, Bastianini V, Corvelyn M, Duelen R, Deschrevel J, De Beukelaer N, De Houwer H, Sampaolesi M, Gayan-Ramirez G, Campenhout AV, Desloovere K. Botulinum Toxin Treatment of Adult Muscle Stem Cells from Children with Cerebral Palsy and hiPSC-Derived Neuromuscular Junctions. Cells 2023; 12:2072. [PMID: 37626881 PMCID: PMC10453788 DOI: 10.3390/cells12162072] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 07/24/2023] [Accepted: 08/08/2023] [Indexed: 08/27/2023] Open
Abstract
Botulinum neurotoxin type-A (BoNT) injections are commonly used as spasticity treatment in cerebral palsy (CP). Despite improved clinical outcomes, concerns regarding harmful effects on muscle morphology have been raised, and the BoNT effect on muscle stem cells remains not well defined. This study aims at clarifying the impact of BoNT on growing muscles (1) by analyzing the in vitro effect of BoNT on satellite cell (SC)-derived myoblasts and fibroblasts obtained from medial gastrocnemius microbiopsies collected in young BoNT-naïve children (t0) compared to age ranged typically developing children; (2) by following the effect of in vivo BoNT administration on these cells obtained from the same children with CP at 3 (t1) and 6 (t2) months post BoNT; (3) by determining the direct effect of a single and repeated in vitro BoNT treatment on neuromuscular junctions (NMJs) differentiated from hiPSCs. In vitro BoNT did not affect myogenic differentiation or collagen production. The fusion index significantly decreased in CP at t2 compared to t0. In NMJ cocultures, BoNT treatment caused axonal swelling and fragmentation. Repeated treatments impaired the autophagic-lysosomal system. Further studies are warranted to understand the long-term and collateral effects of BoNT in the muscles of children with CP.
Collapse
Affiliation(s)
- Domiziana Costamagna
- Neurorehabilitation Group, Department of Rehabilitation Sciences, KU Leuven, 3000 Leuven, Belgium; (D.C.); (V.B.); (N.D.B.)
- Stem Cell and Developmental Biology Unit, Department of Development and Regeneration, KU Leuven, 3000 Leuven, Belgium; (M.C.); (R.D.); (M.S.)
| | - Valeria Bastianini
- Neurorehabilitation Group, Department of Rehabilitation Sciences, KU Leuven, 3000 Leuven, Belgium; (D.C.); (V.B.); (N.D.B.)
| | - Marlies Corvelyn
- Stem Cell and Developmental Biology Unit, Department of Development and Regeneration, KU Leuven, 3000 Leuven, Belgium; (M.C.); (R.D.); (M.S.)
| | - Robin Duelen
- Stem Cell and Developmental Biology Unit, Department of Development and Regeneration, KU Leuven, 3000 Leuven, Belgium; (M.C.); (R.D.); (M.S.)
- Cardiology, Department of Cardiovascular Sciences, KU Leuven, 3000 Leuven, Belgium
| | - Jorieke Deschrevel
- Laboratory of Respiratory Diseases and Thoracic Surgery, Department of Chronic Diseases and Metabolism, KU Leuven, 3000 Leuven, Belgium; (J.D.); (G.G.-R.)
| | - Nathalie De Beukelaer
- Neurorehabilitation Group, Department of Rehabilitation Sciences, KU Leuven, 3000 Leuven, Belgium; (D.C.); (V.B.); (N.D.B.)
- Willy Taillard Laboratory of Kinesiology, Geneva University Hospitals and University of Geneva, 1211 Geneva, Switzerland
| | - Hannah De Houwer
- Department of Orthopedic Surgery, University Hospitals Leuven, 3000 Leuven, Belgium; (H.D.H.); (A.V.C.)
| | - Maurilio Sampaolesi
- Stem Cell and Developmental Biology Unit, Department of Development and Regeneration, KU Leuven, 3000 Leuven, Belgium; (M.C.); (R.D.); (M.S.)
| | - Ghislaine Gayan-Ramirez
- Laboratory of Respiratory Diseases and Thoracic Surgery, Department of Chronic Diseases and Metabolism, KU Leuven, 3000 Leuven, Belgium; (J.D.); (G.G.-R.)
| | - Anja Van Campenhout
- Department of Orthopedic Surgery, University Hospitals Leuven, 3000 Leuven, Belgium; (H.D.H.); (A.V.C.)
- Department of Development and Regeneration, KU Leuven, 3000 Leuven, Belgium
| | - Kaat Desloovere
- Neurorehabilitation Group, Department of Rehabilitation Sciences, KU Leuven, 3000 Leuven, Belgium; (D.C.); (V.B.); (N.D.B.)
| |
Collapse
|
2
|
The Use of a Fixed 50:50 Mixture of Nitrous Oxide and Oxygen to Reduce Lumbar Puncture-Induced Pain in the Emergency Department: A Randomized Controlled Trial. J Clin Med 2022; 11:jcm11061489. [PMID: 35329815 PMCID: PMC8953352 DOI: 10.3390/jcm11061489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 02/28/2022] [Accepted: 03/07/2022] [Indexed: 02/01/2023] Open
Abstract
Lumbar puncture (LP) is stressful and often painful. We evaluated the efficacy of a fixed 50% nitrous oxide−oxygen mixture (50%N2O-O2) versus placebo to reduce immediate procedural pain and anxiety during LP performed in an emergency setting. We conducted a randomized controlled trial involving adults who needed a cerebrospinal fluid analysis in an emergency department. Patients were randomly assigned to inhale either 50%N2O-O2 or medical air. The primary endpoint, assessed using a numerical scale, was the maximum pain felt by the patient during the procedure and the maximum anxiety and satisfaction as secondary outcomes. Eighty-eight patients were randomized and analyzed (ITT). The maximal pain was 5.0 ± 2.9 for patients receiving air and 4.2 ± 3.0 for patients receiving 50%N2O-O2 (effect-size = −0.27 [−0.69; 0.14], p = 0.20). LP-induced anxiety was 4.7 ± 2.8 vs. 3.7 ± 3.7 (p = 0.13), and the proportion of patients with significant anxiety (score ≥ 4/10) was 72.7% vs. 50.0% (p = 0.03). Overall satisfaction was higher among patients receiving 50%N2O-O2 (7.4 ± 2.4 vs. 8.9 ± 1.6, p < 0.001). No serious adverse events were attributable to 50%N2O-O2 inhalation. Although inhalation of 50%N2O-O2 failed to reduce LP-induced pain in an emergency setting, it tended to reduce anxiety and significantly increased patient satisfaction.
Collapse
|
3
|
Chaghazardi S, Hedari M, Bazargan-Hejazi S, Mohammadi R, Ahmadi A. Comparing the Effect of Gabapentin, Ketamine, Dexmedetomidine, and Entonox on Pain Control in Burn Wound Dressing. J Burn Care Res 2021; 41:151-158. [PMID: 31630182 DOI: 10.1093/jbcr/irz142] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
This study aimed to evaluate differences in the experience of pain, nausea, and vomiting, as well as the hemodynamic parameters including heart rate (HR) and blood pressure (BP) in burn patients across four pain treatment groups-i.e., gabapentin, ketamine, dexmedetomidine, and entonox. In a single blinded randomized comparative study, 25 burn patients with second- or third-degree burns between 20% and 50% of their body surface were assigned to different treatment groups by using block randomization, while keeping the investigator blind to the size of the block. We recorded demographics, the hemodynamics, adverse effects, and pain levels before the treatment and again 5, 10, 15, 30, 60, 120, 240, and 360 minutes postadministration of pain medication (after-treatment). Gabapentin ketamine, dexmedetomidine, and entonox had significant effects in treatment of pain in burn patients. Entonox had the best analgesic effect with the least adverse effects and hemodynamic changes. Gabapentin also had good pain management effects; however, it showed less desirable effects on hemodynamic variables. Entonox caused the least amount of hemodynamic changes and the least adverse reactions, but since the medication is delivered by a facemask it limited its application with our patients. Gabapentin offered good benefits but caused a gradual drop in BP and HR and had some unfavorable reactions. However, since it is administered orally and often is cheaper, it could be considered as the drug of choice.
Collapse
Affiliation(s)
- Simin Chaghazardi
- Injury and Pain Management Research Center, Department of Anesthesiology Critical Care and Pain Management, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mohammadbagher Hedari
- Injury and Pain Management Research Center, Department of Anesthesiology Critical Care and Pain Management, Kermanshah University of Medical Sciences, Kermanshah, Iran.,Department of Surgery, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Shahrzad Bazargan-Hejazi
- Department of Psychiatry, College of Medicine, Charles Drew University of Medicine and Science & David Geffen School of Medicine at University of California, Los Angeles (UCLA), CA
| | - Reza Mohammadi
- Department of Neurobiology, Care Sciences and Society (NVS), Division of Family Medicine and Primary Care, Karolinska Institutet, Huddinge, Sweden
| | - Alireza Ahmadi
- Department of Anesthesiology Critical Care and Pain Management, Kermanshah University of Medical Sciences, Kermanshah, Iran
| |
Collapse
|
4
|
Fidalgo M, Prud’homme T, Allio A, Bronnec M, Bulteau S, Jolliet P, Victorri-Vigneau C. Nitrous oxide: What do we know about its use disorder potential? Results of the French Monitoring Centre for Addiction network survey and literature review. Subst Abus 2019; 40:33-42. [DOI: 10.1080/08897077.2019.1573210] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Martin Fidalgo
- Department of Pharmacology, Addictovigilance (Monitoring Centre for Addiction), Nantes University Hospital, Nantes, France
| | - Tony Prud’homme
- Department of Pedodonty, Nantes University Hospital, Nantes, France
- INSERM UMR U1246 SPHERE, Institut de Recherche en Santé 2, Nantes, France
| | - Adrien Allio
- Department of Pharmacology, Addictovigilance (Monitoring Centre for Addiction), Nantes University Hospital, Nantes, France
| | - Marie Bronnec
- INSERM UMR U1246 SPHERE, Institut de Recherche en Santé 2, Nantes, France
- Department of Addictology, Nantes University Hospital, Bâtiment Louis Philippe, Hôpital Saint Jacques, Nantes, France
| | - Samuel Bulteau
- INSERM UMR U1246 SPHERE, Institut de Recherche en Santé 2, Nantes, France
- Department of Psychiatry, Nantes University Hospital, Nantes, France
| | - Pascale Jolliet
- Department of Pharmacology, Addictovigilance (Monitoring Centre for Addiction), Nantes University Hospital, Nantes, France
- INSERM UMR U1246 SPHERE, Institut de Recherche en Santé 2, Nantes, France
| | - Caroline Victorri-Vigneau
- Department of Pharmacology, Addictovigilance (Monitoring Centre for Addiction), Nantes University Hospital, Nantes, France
- INSERM UMR U1246 SPHERE, Institut de Recherche en Santé 2, Nantes, France
| |
Collapse
|
5
|
Cazarim GDS, Verçosa N, Carneiro L, Pastor R, da Silva EFV, Barrucand L, Cavalcanti IL. A 50-50% mixture of nitrous oxide-oxygen in transrectal ultrasound-guided prostate biopsy: A randomized and prospective clinical trial. PLoS One 2018; 13:e0195574. [PMID: 29702684 PMCID: PMC5922537 DOI: 10.1371/journal.pone.0195574] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 03/20/2018] [Indexed: 11/30/2022] Open
Abstract
Introduction Transrectal ultrasound-guided biopsy (TUSPB) is the standard method of diagnosis for prostate cancer, and although it is well tolerated by some patients, it presents a discomfort rate of 65 to 90%, which may be associated with pain. For convenience, it is agreed that a method of analgesia and sedation is necessary. For this purpose, this study aimed to evaluate the impact of inhalation of a 50–50% N2O-O2 gas mixture on pain intensity in these patients. Material and methods Randomized, double-blinded clinical trial, conducted at Antônio Pedro University Hospital (Hospital Universitário Antônio Pedro), Niterói, RJ, Brazil, containing two groups of 42 patients: a control (C) group, which received 100% oxygen inhalation, and a nitrous oxide (NO) group, which received inhalation of the 50–50% N2O-O2 mixture, self-administered during TUSPB. The pain intensity and degree of satisfaction were evaluated through a visual analogue scale (VAS), as was the frequency of adverse events. Results Eighty-four patients were included in the study, with 42 in each group. The mean pain intensity was lower in the NO group than in the C group [2.52 (0–10) vs 5.95 (0–10), p < 0.001], and the degree of satisfaction was higher in the NO group than in the C group (8.14 vs. 4.69, p < 0.001). The adverse effects were somnolence, dizziness, nausea, vomiting, discomfort and euphoria without differences between the groups. Conclusion The 50–50% N2O-O2 mixture was effective in reducing pain intensity and increasing the degree of satisfaction in TUSPB, with tolerable side effects.
Collapse
Affiliation(s)
- Gabriel da Silva Cazarim
- Department of Anesthesiology, Federal Fluminense University, University hospital Antonio Pedro, Niterói, Rio de janeiro, Brazil
- * E-mail:
| | - Nubia Verçosa
- Department of Anesthesiology, Federal University of Rio de Janeiro, University hospital Clementino Fraga Fihlo, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Leonel Carneiro
- Department of Anesthesiology, Federal Fluminense University, University hospital Antonio Pedro, Niterói, Rio de janeiro, Brazil
| | - Rachel Pastor
- Department of Anesthesiology, Federal Fluminense University, University hospital Antonio Pedro, Niterói, Rio de janeiro, Brazil
| | | | - Louis Barrucand
- Department of Statistic, Federal University of Rio de Janeiro, University hospital Clementino Fraga Fihlo, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Ismar Lima Cavalcanti
- Department of Anesthesiology, Federal Fluminense University, University hospital Antonio Pedro, Niterói, Rio de janeiro, Brazil
| |
Collapse
|
6
|
Victorri-Vigneau C, Paille C, Joyau C, Veyrac G, Cosset C, Le Pelletier A, Jolliet P, Nizard J, Kuhn E. [MEOPA use practices in a university hospital: Which conformity?]. Therapie 2017. [PMID: 28647109 DOI: 10.1016/j.therap.2017.04.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
INTRODUCTION MEOPA (equimolar mixture of oxygen and nitrous oxide) is used for its analgesic and anxiolytic properties in order to obtain conscious sedation of the patient when performing painful care. It is subject to an enhanced pharmacovigilance and addictovigilance monitoring. In this context, it is important to dispose of hospital utilization data. This work aims to assess the compliance of the use of nitrous oxide regarding the recommendations of the summary of product characteristics, in a French university hospital (Nantes) and consider possible improvements. MATERIALS AND METHODS Transversal descriptive study, conducted in 2014 with all health professionals using MEOPA. RESULTS Two thousand thirty-four health professionals answered the questionnaire ; durations of administrations are in conformity and the premises are generally appropriate but almost 60% of professionals have the feeling of inhaling the drug. The systematization of the prescription (always or almost always prescribed for 67% of professionals) and traceability of use (always or almost always in the patient's file for 71% of professionals) are potential source of improvement, particularly since 18% of professional health reported "abuse demands" from patients. CONCLUSION The formation and information of health professionals are major issues of good use of nitrous oxide.
Collapse
Affiliation(s)
- Caroline Victorri-Vigneau
- Service de pharmacologie clinique, addictovigilance, CHU de Nantes, 44000 Nantes, France; Inserm UMR1246, universités de Nantes et Tours, 44200 Nantes, France.
| | - Cécile Paille
- Service d'évaluation médicale et d'épidémiologie, santé publique et santé au travail, CHU de Nantes, 44000, Nantes, France
| | - Caroline Joyau
- Service de pharmacologie clinique, pharmacovigilance, CHU de Nantes, 44000, Nantes, France
| | - Gwenaëlle Veyrac
- Service de pharmacologie clinique, pharmacovigilance, CHU de Nantes, 44000, Nantes, France
| | - Claire Cosset
- Unité mobile douleur, centre fédératif douleur, soins palliatifs et soins de support, CHU de Nantes, 44000, Nantes, France
| | - Aline Le Pelletier
- Pharmacie hospitalière, pharmacie clinique, CHU de Nantes, 44000, Nantes, France
| | - Pascale Jolliet
- Service de pharmacologie clinique, addictovigilance, CHU de Nantes, 44000 Nantes, France; Inserm UMR1246, universités de Nantes et Tours, 44200 Nantes, France
| | - Julien Nizard
- Unité mobile douleur, centre fédératif douleur, soins palliatifs et soins de support, CHU de Nantes, 44000, Nantes, France
| | - Emmanuelle Kuhn
- Unité mobile douleur, centre fédératif douleur, soins palliatifs et soins de support, CHU de Nantes, 44000, Nantes, France
| |
Collapse
|
7
|
Moisset X, Sia MA, Pereira B, Taithe F, Dumont E, Bernard L, Clavelou P. Fixed 50:50 mixture of nitrous oxide and oxygen to reduce lumbar-puncture-induced pain: a randomized controlled trial. Eur J Neurol 2016; 24:46-52. [PMID: 27666149 DOI: 10.1111/ene.13127] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Accepted: 08/09/2016] [Indexed: 11/27/2022]
Abstract
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.
Collapse
Affiliation(s)
- X Moisset
- Service de Neurologie, CHU Clermont-Ferrand, Clermont-Ferrand, France.,Clermont-Ferrand and Inserm U1107, Clermont Université, Université d'Auvergne, Neuro-Dol, Clermont-Ferrand, France
| | - M A Sia
- Service de Neurologie, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - B Pereira
- Biostatistics Unit, Délégation Recherche Clinique et Innovation, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - F Taithe
- Service de Neurologie, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - E Dumont
- Service de Neurologie, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - L Bernard
- Pôle pharmacie, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - P Clavelou
- Service de Neurologie, CHU Clermont-Ferrand, Clermont-Ferrand, France.,Clermont-Ferrand and Inserm U1107, Clermont Université, Université d'Auvergne, Neuro-Dol, Clermont-Ferrand, France
| |
Collapse
|
8
|
Pansieri M, Barnay P, Larderet E, Krebs G, Aboukhoudir F, Andrieu S, Cheggour S, Faugier JP, Metge M, Hirsch JL. [Renal denervation for resistant hypertension without general anesthesia: advantage of a MEOPA morphine protocol. Preliminary experience]. Ann Cardiol Angeiol (Paris) 2013; 62:283-6. [PMID: 24060464 DOI: 10.1016/j.ancard.2013.08.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Accepted: 08/14/2013] [Indexed: 11/27/2022]
Abstract
UNLABELLED Renal denervation using the technique of radiofrequency is used only recently for the treatment of resistant hypertension. Normally, it is done under general anesthesia because the ablation point technique is painful. We suggest an alternative to general anesthesia comprising an association of morphin 0.1mg/kg IV to MEOPA (gas combining oxygen and azot protoxyd) delivered through an oxygen mask. Our series includes 12 consecutive patients treated between October 2011 and June 2013, the first five patients (group 1) have received only an hydroxizin and morphin sedation. Every five have felt the ablation painful, in two cases bearable pain (EVA<5), in three cases intense (EVA>5) pain leading to increasing doses of morphin, (total dose of 0.25mg/kg in two cases, 0.17mg in one case). For the seven following patients, a protocol including hydroxyzin, morphin and MEOPA given through a mask has been set up. Only one patient has felt a mild pain (EVA 5) leading to an increasing dose of morphin (total dose 0.17mg/kg). None of the six other patients has felt any pain during the procedure. The average dose of morphin is 0.17mg/kg in group 1, 0.11mg/kg in group 2. This is a preliminary study; if confirmed, it will allow a lot of hospitals without on-site possibilities of general anesthesia, to realize such procedures. CONCLUSION regarding pain, the procedure of renal ablation was well tolerated for six among seven patients receiving the association MEOPA and IV morphin. In contrast, in the five patients treated only with IV morphin, we observed a less good tolerance to pain and the need to increase the doses of IV morphin.
Collapse
Affiliation(s)
- M Pansieri
- Service de cardiologie, centre hospitalier, 305, rue Raoul-Follereau, 84902 Avignon cedex 9, France.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
9
|
Yuxiang L, Lu T, Jianqiang Y, Xiuying D, Wanfang Z, Wannian Z, Xiaoyan H, Shichu X, Wen N, Xiuqiang M, Yinsheng W, Ming Y, Guoxia M, Guangyi W, Wenjun H, Zhaofan X, Hongtai T, Jijun Z. Analgesia effect of a fixed nitrous oxide/oxygen mixture on burn dressing pain: study protocol for a randomized controlled trial. Trials 2012; 13:67. [PMID: 22624697 PMCID: PMC3404913 DOI: 10.1186/1745-6215-13-67] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2011] [Accepted: 05/24/2012] [Indexed: 11/17/2022] Open
Abstract
Background Procedural burn pain is the most intense acute pain and most likely type of burn injury pain to be undertreated due to the physician’s fear of the adverse effect of analgesia and lack of anesthetist present. At our institution, in most of the cases, local burn detersion and debridement were performed at the ward level without any analgesics. This article describes a study designed to test the analgesia effect of a fixed nitrous oxide/oxygen mixture on burn dressing pain. Methods/design The experiment was carried out in three centers. The patients were given a number from 1 to 240. A randomization list was produced by a statistician according to our preliminary study. Due to the severity of the pain suffered, ethically it was decided to help as many as possible, so patients given the letters A, B or C were treated using a canister with the appropriate letter containing preprepared nitrous oxide/oxygen mixture (NOOM). Those with D were given oxygen only, from an identical-looking canister labeled D. Neither patients, nor doctors, nor nurses, nor data collector knew what was in each canister, thus they were all blind. The nursing officer who implemented the intervention handed the doctors envelopes containing the patients’ name and allocation of A, B, C or D. Thus, patients receiving NOOM or oxygen were in the ratio 3:1. Parameters, including pain severity, blood pressure, heart rate, digital oxygen saturation and the Chinese version of the burn specific pain anxiety scale (C-BSPAS), were taken before, during and after dressing for each group. A video and audio record was taken individually for later communication coding and outcome analysis. Rescue analgesic was recorded. Discussion Based on the findings from our previous qualitative study that physician’s reluctance to order narcotic analgesia is due to its adverse effect and from our pilot experiment, this study aims to test the hypothesis that a fixed nitrous oxide/oxygen mixture will promote better burn dressing pain alleviation and outcomes. Analyses will focus on the effects of the experimental intervention on pain severity during dressing (primary outcomes); physiological parameters, C-BSPAS and acceptance of both health care professionals and patients (secondary outcomes). If this model of analgesia for burn pain management implemented by nurses proves successful, it could potentially be implemented widely in hospital and prehospital settings and improve patients’ satisfaction and quality of life. Trial registration (Clinical Trials Identifier: CHICTR-TRC11001690).
Collapse
Affiliation(s)
- Li Yuxiang
- Department of Nursing, Changhai Hospital, Second Military Medical University, 168 Changhai Road, Shanghai 200433, China
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
10
|
Hennequin M, Collado V, Faulks D, Koscielny S, Onody P, Nicolas E. A clinical trial of efficacy and safety of inhalation sedation with a 50% nitrous oxide/oxygen premix (Kalinox™) in general practice. Clin Oral Investig 2011; 16:633-42. [DOI: 10.1007/s00784-011-0550-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2010] [Accepted: 03/16/2011] [Indexed: 11/30/2022]
|
11
|
Claeys A, Gaudy-Marqueste C, Pauly V, Pelletier F, Truchetet F, Boye T, Aubin F, Schmutz JL, Grob JJ, Richard MA. Management of pain associated with debridement of leg ulcers: a randomized, multicentre, pilot study comparing nitrous oxide-oxygen mixture inhalation and lidocaïne-prilocaïne cream. J Eur Acad Dermatol Venereol 2010; 25:138-44. [DOI: 10.1111/j.1468-3083.2010.03720.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
12
|
Gayet S, Bernit E, Sati H, Veit V, Mazodier K, Schleinitz N, Kaplanski G, Harlé JR. Antalgie par mélange équimolaire d’oxygène et de protoxyde d’azote lors des biopsies ostéomédullaires. Rev Med Interne 2009; 30:208-14. [DOI: 10.1016/j.revmed.2008.09.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2008] [Revised: 08/29/2008] [Accepted: 09/21/2008] [Indexed: 10/21/2022]
|
13
|
Lepage L, Frangie MC, Detaint D, Brochet E, Guegueniat J, Partouche G, Iung B, Vahanian A, Messika-Zeitoun D. Nitrous oxide inhalation for transoesophageal echocardiography: an alternative to benzodiazepine sedation? EUROPEAN JOURNAL OF ECHOCARDIOGRAPHY 2008; 9:621-4. [PMID: 18296403 DOI: 10.1093/ejechocard/jen014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
AIMS Transoesophageal echocardiography (TEE) is usually performed using benzodiazepine sedation, which is a limiting factor for elderly patients or those with respiratory insufficiency. Kalinox, an equimolar mixture of nitrous oxide and oxygen, with no depressive respiratory action and fast reversible effects, seems ideally suited for performing TEE but has never been evaluated. The aim of the present study was to evaluate the TEE feasibility and efficiency using Kalinox compared with the standard care using benzodiazepine. METHODS AND RESULTS We prospectively enrolled 80 consecutive patients referred for TEE. In the 35 first patients, TEE was performed using intravenous benzodiazepine (Midazolam) and in the 45 last patients using Kalinox (nasal delivery). Pain and tolerance induced by the examination were evaluated on a 0-10 scale. Remembrance of the examination by the patient and quality of the TEE by the operator were also evaluated. All TEEs were performed by the same experienced operator. TEE duration was not different (6 +/- 3 vs. 7 +/- 4 min, respectively, P = 0.57). Patients in the Kalinox group felt TEE to be more difficult (P = 0.005) and remembered the procedure more clearly (P < 0.0001) but pain experience was not different (7 vs. 9% had a pain score >or=5, respectively, P = 0.75). Percentage of patients who agreed to have a second TEE if necessary was slightly lower (77 vs. 94%, respectively, P = 0.04). The operator judged TEE quality satisfactory in similar proportions (76 vs. 68%, respectively, P = 0.44). CONCLUSION These preliminary results show that TEE using Kalinox is feasible, provides similar pain relief despite more discomfort for the patient, and acceptable conditions for the operator. Thus, Kalinox use could be considered as an alternative to benzodiazepine sedation for patients intolerant to benzodiazepines such as elderly or respiratory-insufficient patients.
Collapse
Affiliation(s)
- Laurent Lepage
- AP-HP, Cardiovascular Division, Bichat Hospital, 46 rue Henri Huchard, 75018 Paris, France
| | | | | | | | | | | | | | | | | |
Collapse
|
14
|
|
15
|
Mazdak H, Abazari P, Ghassami F, Najafipour S. The analgesic effect of inhalational Entonox for extracorporeal shock wave lithotripsy. ACTA ACUST UNITED AC 2007; 35:331-4. [PMID: 17982746 PMCID: PMC2082064 DOI: 10.1007/s00240-007-0120-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2007] [Accepted: 10/16/2007] [Indexed: 12/02/2022]
Abstract
Extracorporeal shock wave lithotripsy (ESWL) is a non-invasive procedure that allows urinary stones to be fragmented using acoustic shock waves. The impact of the shock waves causes transient stinging pain at the entry site as well as deep visceral discomfort, requiring analgesia during the procedure. The objective of this study was to compare the clinical efficacy of Entonox and pethidine for pain relief during outpatient ESWL. We randomized 150 outpatients undergoing elective ESWL into three groups of 50 patients, each group receiving inhalational Entonox, intravenous pethidine, or inhalational compressed air during ESWL. Quantitative evaluation of pain was performed according to a visual analogue scale (VAS), before and after the intervention. Analysis of variance (ANOVA) and paired t tests were used to compare VAS scores in the three groups, before and after the intervention. Entonox and pethidine decreased the pain score significantly, while compressed air did not. There was no significant difference between pain relief by Entonox and pethidine. This study demonstrates for the first time that inhalational Entonox is an effective analgesic regimen for ESWL. Entonox can be regarded as an appropriate alternative to analgesics like opioids in relieving pain during ESWL.
Collapse
Affiliation(s)
- Hamid Mazdak
- Department of Urology, Alzahra Hospital, Isfahan Medical University, Isfahan, Iran.
| | | | | | | |
Collapse
|
16
|
Garbaz L, Mispelaere D, Boutemy M, Jounieaux V. [Pneumothorax following recreational inhalation of nitrous oxide]. Rev Mal Respir 2007; 24:622-4. [PMID: 17519814 DOI: 10.1016/s0761-8425(07)91130-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
CASE REPORT A 21 year old man was admitted to hospital as an emergency complaining of left sided chest pain. Chest radiograph revealed a complete non compressive left-sided pneumothorax which resolved following thoracic drainage. A more detailed history revealed repeated and regular use of nitrous oxide by inhalation, for its consciousness-altering effect during rave parties. DISCUSSION The principal side effects occurring as a consequence of repeated exposures to nitrous oxide are haematological, neuropsychiatric and teratogenic. Rare cases of pneumothorax have been described associated with the use of nitrous oxide occurring as complications of anaesthesia or during laparoscopy where gas diffuses from the abdominal to the pleural cavity. Illicit use of nitrous oxide is rare and usually occurs in medical workers. Its spreading to the public may lead to accidents and unanticipated side effects. CONCLUSION Inhaled nitrous oxide can reveal asymptomatic pneumothorax by worsening it. The consequences can be dramatic in case of illicit use because of ignorance of side effects.
Collapse
Affiliation(s)
- L Garbaz
- Service de pneumologie et réanimation respiratoire, CHU Amiens, France
| | | | | | | |
Collapse
|
17
|
Current World Literature. Curr Opin Anaesthesiol 2006; 19:660-5. [PMID: 17093372 DOI: 10.1097/aco.0b013e3280122f5d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
18
|
Affiliation(s)
- F Veyckemans
- Service d'anesthésiologie, cliniques universitaires Saint-Luc, 10-1821, avenue Hippocrate, 1200 Bruxelles, Belgique.
| |
Collapse
|