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Hale J, Xu J, Wang D, Rodriguez-Patarroyo F, Bakal O, Kopac O, Yamak Altinpulluk E, Onal O, Brooker JE, Cruz M, Maurtua M, Agudelo-Jimenez R, Sessler DI, Turan A. Nitrous oxide for the treatment of complex regional pain syndrome: a randomized blinded trial. Reg Anesth Pain Med 2024; 49:573-580. [PMID: 37898481 PMCID: PMC11055939 DOI: 10.1136/rapm-2023-104537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 10/02/2023] [Indexed: 10/30/2023]
Abstract
INTRODUCTION Complex Regional Pain Syndrome (CRPS) is a debilitating neuropathic condition often refractory to conventional treatments. N-methyl-D-aspartate (NMDA) receptor antagonists have a well-established role in the development and modulation of chronic neuropathic pain. Nitrous oxide is widely used and generally safe anesthetic gas with NMDA receptor antagonist activity. We therefore tested the hypothesis that brief periods of nitrous oxide exposure reduce pain in patients with CRPS. METHODS Patients with a diagnosis of CRPS were randomized to either 2 hours of nitrous oxide exposure on three alternating days (Nitrous Oxide) versus a placebo air/oxygen mixture (Air-Oxygen). Our primary outcome was patient-reported pain scores at 1 week and 1 month. Secondary and exploratory outcomes were physical and mental health (PRMOIS-29 v2 survey), specific neuropathic pain symptoms (McGill short-form questionnaire), and opioid consumption. RESULTS 44 patients participated in the study; 20 were randomized to Nitrous Oxide and 24 were assigned to Air-Oxygen. Pain scores did not differ significantly, with the estimated difference in means (Nitrous Oxide-Air-Oxygen) of -0.57 (95% CI: -1.42 to 0.28) points, p=0.19. There were also no differences detected in secondary outcomes, with the estimated difference in mean Z-scores for physical health (Nitrous Oxide-Air-Oxygen) of 0.13 (95% CI: -0.16 to 0.43), mental health 0.087 (95% CI: -0.31 to 0.48), and Patient Global Impression of Change score -0.7 (95% CI: -1.85 to 0.46). CONCLUSIONS Compared with air/oxygen, 2 hours of nitrous oxide/oxygen exposure for three sessions did not provide meaningful therapeutic potential for patients with chronic CRPS. Our results do not support using nitrous oxide for the treatment of CRPS.
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Affiliation(s)
- Jason Hale
- Department of Pain Management, Cleveland Clinic, Cleveland, Ohio, USA
| | - Jijun Xu
- Department of Pain Management, Cleveland Clinic, Cleveland, Ohio, USA
| | - Dong Wang
- Department of Outcomes Research, Cleveland Clinic, Cleveland, Ohio, USA
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio, USA
| | | | - Omer Bakal
- Department of Outcomes Research, Cleveland Clinic, Cleveland, Ohio, USA
| | - Orkun Kopac
- Department of Outcomes Research, Cleveland Clinic, Cleveland, Ohio, USA
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, School of Medicine, Pittsburgh, Pennsylvania, USA
| | | | - Ozkan Onal
- Department of Outcomes Research, Cleveland Clinic, Cleveland, Ohio, USA
- Department of Anesthesiology and Reanimation, Selcuk Universitesi, Konya, Turkey
| | - Jack E Brooker
- Department of Outcomes Research, Cleveland Clinic, Cleveland, Ohio, USA
| | - Miguel Cruz
- Department of General Anesthesiology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Marco Maurtua
- Department of General Anesthesiology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Ruben Agudelo-Jimenez
- Department of Outcomes Research, Cleveland Clinic, Cleveland, Ohio, USA
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington, USA
| | - Daniel I Sessler
- Department of Outcomes Research, Cleveland Clinic, Cleveland, Ohio, USA
| | - Alparslan Turan
- Department of Outcomes Research, Cleveland Clinic, Cleveland, Ohio, USA
- Department of General Anesthesiology, Cleveland Clinic, Cleveland, Ohio, USA
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Combination of inhaled nitrous oxide and oral opioids induces long-lasting analgesic effects in patients with neuropathic pain: ProtoTOP study post hoc exploratory analyses. Pain 2021; 163:e1021-e1029. [PMID: 35050957 DOI: 10.1097/j.pain.0000000000002570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 12/14/2021] [Indexed: 11/26/2022]
Abstract
ABSTRACT Experimental studies have suggested that nitrous oxide-induced analgesia depends on interactions with opioids. On the basis of these results, we hypothesized that the effects of inhaled nitrous oxide/oxygen (N2O/O2) 50%-50% equimolar mixture (EMONO) on patients with neuropathic pain would be higher in those receiving concomitant opioids. To test this hypothesis, we did exploratory post hoc analyses of our recently published ProtoTOP study to compare the effects of EMONO and placebo in patients with or without concomitant opioid treatment. A total of 92 patients of the 221 (ie, 41.6%) included in the ProtoTOP study were concomitantly treated with opioids. In contrast with our previous analyses, average pain intensity was significantly decreased in comparison with placebo one week after the last treatment administration in patients treated with opioids, but not in those treated without opioid, and this effect was maintained over the 4-week follow-up period. Neuropathic pain symptom inventory (NPSI total and subscores) was also significantly more decreased after inhalation of EMONO in comparison with placebo only in patients receiving opioids. The proportion of patients with at least 30% pain reduction and of those reporting an overall improvement with the Patient Global Impression of Change were significantly higher only in this population of patients. In conclusion, these results complement our previous analyses with the identification of a specific population of responders to EMONO inhalation in patients with neuropathic pain. As suggested by experimental studies, we hypothesized that these long-lasting analgesic effects could depend on the anti-N-methyl-D-aspartate properties of N2O.
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Evaluation of antihyperalgesic and analgesic effects of 35% nitrous oxide when combined with remifentanil: A randomised phase 1 trial in volunteers. Eur J Anaesthesiol 2021; 38:1230-1241. [PMID: 34735395 DOI: 10.1097/eja.0000000000001468] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Remifentanil is an effective drug in peri-operative pain therapy, but it can also induce and aggravate hyperalgesia. Supplemental administration of N2O may help to reduce remifentanil-induced hyperalgesia. OBJECTIVE To evaluate the effect of 35 and 50% N2O on hyperalgesia and pain after remifentanil infusion. DESIGN Single site, phase 1, double-blind, placebo-controlled, randomised crossover study. SETTING University Hospital, Germany from January 2012 to April 2012. PARTICIPANTS Twenty-one healthy male volunteers. INTERVENTIONS Transcutaneous electrical stimulation induced spontaneous acute pain and stable areas of hyperalgesia. Each volunteer underwent the following four sessions in a randomised order: 50 to 50% N2-O2 and intravenous (i.v.) 0.9% saline infusion (placebo); 50 to 50% N2-O2 and i.v. remifentanil infusion at 0.1 μg kg-1 min-1 (remifentanil); 35 to 15 to 50% N2O-N2-O2 and i.v. remifentanil infusion at 0.1 μg kg-1 min-1 (tested drug) and 50 to 50% N2O-O2 and i.v. remifentanil infusion at 0.1 μg kg-1 min-1 (gas active control). Gas mixtures were inhaled for 60 min; i.v. drugs were administered for 30 min. MAIN OUTCOME MEASURES Areas of pin-prick hyperalgesia, areas of touch-evoked allodynia and pain intensity on a visual analogue scale were assessed repeatedly for 160 min. RESULTS Data from 20 volunteers were analysed. There were significant treatment and treatment-by-time effects regarding areas of hyperalgesia (P < 0.001). After the treatment period, the area of hyperalgesia was significantly reduced (P < 0.001) in the tested drug and in the gas active control (30.6 ± 9.25 and 24.4 ± 7.3 cm2, respectively) compared with remifentanil (51.0 ± 17.0 cm2). There was also a significant difference between the gas active control and the tested drug sessions (P < 0.001). For the area of allodynia and pain rating, results were consistent with the results for hyperalgesia. CONCLUSIONS Administration of 35% N2O significantly reduced hyperalgesia, allodynia and pain intensity induced after remifentanil. It might therefore be suitable in peri-operative pain relief characterised by hyperalgesia and allodynia, such as postoperative pain, and may help to reduce opioid demand. TRIAL REGISTRATION EudraCT-No.: 2011-000966-37.
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Kuroiwa K, Harano N, Shigeyama-Tada Y, Ono K, Watanabe S. Effects of inhalation sedation with nitrous oxide on intraoral senses. PEDIATRIC DENTAL JOURNAL 2021. [DOI: 10.1016/j.pdj.2021.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Safety and efficacy of an equimolar mixture of oxygen and nitrous oxide: a randomized controlled trial in patients with peripheral neuropathic pain. Pain 2021; 162:1104-1115. [PMID: 33044394 DOI: 10.1097/j.pain.0000000000002109] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 10/05/2020] [Indexed: 11/25/2022]
Abstract
ABSTRACT Nitrous oxide (N2O) is an odorless and colorless gas routinely used as an adjuvant of anesthesia and for short-duration analgesia in various clinical settings mostly in the form of an N2O/O2 50%-50% equimolar mixture (EMONO). Experimental studies have suggested that EMONO could also induce long-lasting analgesic effects related to the blockade of N-methyl-D-aspartate receptors. We designed the first international multicenter proof of concept randomized, placebo-controlled study to assess the efficacy and safety of a 1-hour administration of EMONO or placebo (medical air) on 3 consecutive days up to 1 month after the last administration in patients with chronic peripheral neuropathic pain. A total of 240 patients were recruited in 22 centers in France and Germany and randomly assigned to 1 study group (120 per group). Average pain intensity (primary outcome), neuropathic pain characteristics (Neuropathic Pain Symptom Inventory), Patient Global Impression of Change, anxiety, depression, and quality of life were systematically assessed before and after treatment. The changes in average pain intensity between baseline and 7 days after the last administration were not significantly different between the 2 groups. However, evoked pain intensity (predefined secondary endpoint) and Patient Global Impression of Change (exploratory endpoint) were significantly improved in the EMONO group, and these effects were maintained up to 4 weeks after the last treatment administration. Mostly transient side effects were reported during the treatment administration. These encouraging results provide a basis for further investigation of the long-term analgesic effects of EMONO in patients with neuropathic pain.
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Coulombe MA, Décary E, Maximos S, Brulotte V, Drolet P, Tanoubi I, Issa R, Zaphiratos V, Verdonck O, Fortier LP, Godin N, Idrissi M, Raft J, Richebé P. Assessing the antinociceptive effect of nitrous oxide to tetanic stimulation in anaesthetised patients with new intra-operative nociception monitors: An observational study. Eur J Anaesthesiol 2021; 38:512-523. [PMID: 33399383 DOI: 10.1097/eja.0000000000001431] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Nitrous oxide (N2O) has been used since the 19th century for its analgesic, antinociceptive and anxiolytic effects during surgical procedures in awake and anaesthetised patients. However, quantification of noxious stimuli that occur under general anaesthesia is a constant challenge for anaesthesiologists, and recently two new indices have been developed to assess intra-operative nociception. OBJECTIVE The aim of this study was to quantify with new indices as well as with more classical clinical parameters the antinociceptive effect of N2O during general anaesthesia. DESIGN Prospective, open label, patient-blinded, observational and descriptive trial. SETTING Single-centre academic hospital. PARTICIPANTS Forty American Society of Anesthesiologists' physical status 1 to 3 patients undergoing general anaesthesia for elective abdominal surgery via laparotomy were recruited. MAIN OUTCOMES MEASURES Intra-operative pain was assessed using a standardised electrical stimulation of the forearm (tetanic stimulation at 70 mA, 100 Hz for 30 s), at 0, 25 and 50% inhaled N2O/O2. Heart rate (HR), mean arterial blood pressure, bispectral index, the analgesia nociception index and the nociception level (NOL) index were used to evaluate intra-operative nociception before and after each standardised tetanic stimulation. RESULTS There was a 16% reduction of the analgesia nociception index reaction, a 31% reduction of the NOL reaction and a 51% reduction of the HR reaction to a standardised electrical tetanic nociceptive stimulation during administration of 50% N2O. Administration of 50 or 25% inhaled N2O produced the same quality of antinociception based on HR and NOL index analyses. HR and the NOL index were the best parameters to identify the antinociceptive effect of intra-operatively administered N2O. CONCLUSION In anaesthetised patients, our study demonstrated clinically significant antinociceptive properties of N2O. Our results showed that low concentrations of N2O (25%) are as effective as higher concentrations (50%) to achieve a significant antinociceptive effect. These findings may help decrease negative effects of using higher concentrations of N2O, including its side effects and its environmental pollution. TRIAL REGISTRATION ClinicalTrials.gov registration identifier: NCT02701478.
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Affiliation(s)
- Marie-Andrée Coulombe
- From the Department of Anesthesiology and Pain Medicine, Maisonneuve-Rosemont Hospital, CIUSSS de l'Est de l'Ile de Montreal, University of Montreal, Montreal, Quebec, Canada (M-AC, ED, SM, VB, PD, IT, RI, VZ, OV, L-PF, NG, MI, JR, PR)
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Bessière B, Iris F, Milet A, Beopoulos A, Billoet C, Farjot G. A new mechanistic approach for the treatment of chronic neuropathic pain with nitrous oxide integrated from a systems biology narrative review. Med Gas Res 2021; 11:34-41. [PMID: 33642336 PMCID: PMC8103977 DOI: 10.4103/2045-9912.310058] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 07/24/2020] [Accepted: 07/24/2020] [Indexed: 12/25/2022] Open
Abstract
The limitations of the currently available treatments for chronic neuropathic pain highlight the need for safer and more effective alternatives. The authors carried out a focused review using a systems biology approach to integrate the complex mechanisms of nociception and neuropathic pain, and to decipher the effects of nitrous oxide (N2O) on those pathways, beyond the known effect of N2O on N-methyl-D-aspartate receptors. This review identified a number of potential mechanisms by which N2O could impact the processes involved in peripheral and central sensitization. In the ascending pathway, the effects of N2O include activating TWIK-related K+ channel 1 potassium channels on first-order neurons, blocking voltage-dependent calcium channels to attenuate neuronal excitability, attenuating postsynaptic glutamatergic receptor activation, and possibly blocking voltage-dependent sodium channels. In the descending pathway, N2O induces the release of endogenous opioid ligands and stimulates norepinephrine release. In addition, N2O may mediate epigenetic changes by inhibiting methionine synthase, a key enzyme involved in DNA and RNA methylation. This could explain why this short-acting analgesic has shown long-lasting anti-pain sensitization effects in animal models of chronic pain. These new hypotheses support the rationale for investigating N2O, either alone or in combination with other analgesics, for the management of chronic neuropathic pain.
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Affiliation(s)
- Baptiste Bessière
- Air Liquide Santé International, Paris Innovation Campus, Jouy-en-Josas, France
| | | | - Aude Milet
- Air Liquide Santé International, Paris Innovation Campus, Jouy-en-Josas, France
| | | | - Catherine Billoet
- Air Liquide Santé International, Paris Innovation Campus, Jouy-en-Josas, France
| | - Géraldine Farjot
- Air Liquide Santé International, Paris Innovation Campus, Jouy-en-Josas, France
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Clinical Trial of Manual Reduction of Temporomandibular Joint Dislocation After Inhalation of Nitrous Oxide. J Craniofac Surg 2019; 30:2549-2550. [DOI: 10.1097/scs.0000000000005816] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Rungwattanakit P, Sondtiruk T, Nimmannit A, Sirivanasandha B. Perioperative Factors Associated with Severe Pain in Post-Anesthesia Care Unit after Thoracolumbar Spine Surgery: A Retrospective Case-Control Study. Asian Spine J 2019; 13:441-449. [PMID: 30685952 PMCID: PMC6547386 DOI: 10.31616/asj.2018.0121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 10/18/2018] [Indexed: 11/23/2022] Open
Abstract
Study Design A retrospective case-control study. Purpose To evaluate the effect of nitrous oxide and anesthetic and operative factors associated with severe pain in the early postoperative period after thoracolumbar spine surgery. Overview of Literature Thoracolumbar spine surgery is the most common procedure in spine surgery, and up to 50% of the patients suffer from moderate to severe pain. Nitrous oxide has analgesic, anxiolytic, and anesthetic effects; nevertheless, its benefits for early postoperative pain control and opioid consumption remain to be established. Methods The medical records of eligible participants who underwent thoracolumbar spine surgery between July 2016 and February 2017 were reviewed. Enrolment was performed consecutively until reaching 90 patients for the case (severe pain) group (patients with a pain score of >7 out of 10 at least once during the post-anesthesia care unit [PACU] admission), and 90 patients for the control (mild-to-moderate pain) group (patients with a pain score of <7 in every PACU assessment). The data collected comprised patient factors, anesthetic factors, surgical factors, PACU pain score, and PACU pain management. Results A total of 197 patients underwent thoracolumbar spine surgery with an incidence of early postoperative severe pain of 53.3%. The case-control study revealed no differences in the factors related to pain intensity. A subgroup analysis was performed for failed back surgery syndrome (FBSS), spinal stenosis, and spondylolisthesis. After multivariate analyses, only the age group of 19–65 years and the baseline Oswestry Disability Index (ODI) were found to be significant risk factors for early postoperative severe pain in the PACU (odds ratio [OR], 2.86; 95% confidence interval [CI], 1.32–6.25; OR, 1.03; 95% CI, 1.01–1.05, respectively). Conclusions Nitrous oxide, anesthetic agents, and surgical techniques did not affect the early postoperative pain severity. Age under 66 years and the baseline ODI were the significant risk factors for pain intensity during the early postoperative period of the FBSS, spinal stenosis, and spondylolisthesis subgroups.
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Affiliation(s)
- Paweenus Rungwattanakit
- Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Tarnkamon Sondtiruk
- Department of Nursing, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Akarin Nimmannit
- Department of Research, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Busara Sirivanasandha
- Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Chompu-inwai P, Simprasert S, Chuveera P, Nirunsittirat A, Sastraruji T, Srisuwan T. Effect of Nitrous Oxide on Pulpal Anesthesia: A Preliminary Study. Anesth Prog 2018; 65:156-161. [PMID: 30235437 PMCID: PMC6148698 DOI: 10.2344/anpr-65-02-08] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Accepted: 08/13/2017] [Indexed: 12/28/2022] Open
Abstract
To compare the success of perceived pulpal anesthesia between groups using nitrous oxide/oxygen (N2O/O2) and oxygen (O2) in children premedicated with ibuprofen with symptomatic irreversible pulpitis permanent teeth. Thirty-three children (mean age 10.4 ± 1.9 years) with 33 symptomatic irreversible pulpitis permanent teeth were included in this preliminary study. All children were premedicated with ibuprofen and randomly assigned to receive either N2O/O2 (17 participants) or O2 (16 participants). Four percent articaine with epinephrine 1:100,000 was administered, and vital pulp therapy was performed. Children used the Wong-Baker FACES Pain Rating Scale (WBFPS) to report their pain at baseline as well as during carious dentin removal, pulpal exposure, and pulpal tissue removal steps. The success was determined when the reported WBFPS score was ≤4. The chi-square test was used to compare the success between both groups. The success of pulpal anesthesia was 71% (12/17) and 19% (3/16) in the N2O/O2 and O2 groups, respectively. The success in the N2O/O2 group was 52% higher than that in the O2 group (confidence interval = 22.9% to 80.7%; significant difference p = .003). From the result of this preliminary study, N2O/O2 significantly increased the success of perceived pulpal anesthesia in children premedicated with ibuprofen with symptomatic irreversible pulpitis permanent teeth. However, further study with a larger sample is required to confirm this result.
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Affiliation(s)
- Papimon Chompu-inwai
- Division of Pediatric Dentistry, Department of Orthodontics and Pediatric Dentistry, Faculty of Dentistry, Chiang Mai University, Chiang Mai, Thailand
| | - Sophon Simprasert
- Former postgraduate student in pediatric dentistry, Faculty of Dentistry, Chiang Mai University, Chiang Mai, Thailand
| | - Patchanee Chuveera
- Department of Family and Community Dentistry, Faculty of Dentistry, Chiang Mai University, Chiang Mai, Thailand
| | - Areerat Nirunsittirat
- Department of Family and Community Dentistry, Faculty of Dentistry, Chiang Mai University, Chiang Mai, Thailand
| | - Thanapat Sastraruji
- Dental Research Center, Faculty of Dentistry, Chiang Mai University, Chiang Mai, Thailand
| | - Tanida Srisuwan
- Division of Endodontics, Department of Restorative Dentistry and Periodontology, Faculty of Dentistry, Chiang Mai University, Chiang Mai, Thailand
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Inhaled nitrous oxide can reduce the pain perception in post Caldwell-Luc operation patients-a randomised trial. Sci Rep 2017; 7:17760. [PMID: 29259196 PMCID: PMC5736561 DOI: 10.1038/s41598-017-15731-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 10/30/2017] [Indexed: 02/07/2023] Open
Abstract
To assess the efficiency of inhaled nitrous oxide (N2O) for the reduce the perception pain in extraction of iodoform gauze packing strips in post Caldwell-Luc operation patients. This randomized single blind trial included a total of 47 patients, aged between 14–82 years, in which undergoing radical maxillary sinusotomy. Based on the randomization procedure, patients were treated with (experimental) or without (control) inhaled N2O. The visual analogue scale scores (VAS scores) of the pain perception and the headache duration time were comparatively studied. The average VAS score for pain perception was 3.92 in the N2O group and 7.87 in the control group. The average headache duration time was 0.12 hour in the N2O group and 13.09 hours in the control group. Both VAS scores for pain perception during the treatment and the average headache duration time were significantly reduced in the inhaled N2O group (P < 0.01). Reduced pain perception and headache duration time indicated that, the inhaled N2O method might be viable in extraction of iodoform gauze packing strips in post Caldwell-Luc operation patients.
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Krystal JH, Petrakis IL, O’Malley S, Krishnan-Sarin S, Pearlson G, Yoon G. NMDA Glutamate Receptor Antagonism and the Heritable Risk for Alcoholism: New Insights from a Study of Nitrous Oxide. Int J Neuropsychopharmacol 2017; 20:351-353. [PMID: 28158462 PMCID: PMC5409033 DOI: 10.1093/ijnp/pyw118] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Revised: 12/21/2016] [Accepted: 01/16/2017] [Indexed: 11/13/2022] Open
Affiliation(s)
- John H Krystal
- Departments of Psychiatry and Neuroscience, Yale University School of Medicine, New Haven, Connecticut (Drs Krystal, Petrakis, O’Malley, Krishnan-Sarin, Pearlson, and Yoon); Psychiatry Services, VA Connecticut Healthcare System, West Haven, Connecticut (Drs Krystal, Petrakis, and Yoon); Behavioral Health Services, Yale-New Haven Hospital, New Haven, Connecticut (Drs Krystal, Petrakis, and Yoon); Olin Center for Neuropsychiatry Research, Institute of Living, Hartford, Connecticut (Dr Pearlson)
| | - Ismene L Petrakis
- Departments of Psychiatry and Neuroscience, Yale University School of Medicine, New Haven, Connecticut (Drs Krystal, Petrakis, O’Malley, Krishnan-Sarin, Pearlson, and Yoon); Psychiatry Services, VA Connecticut Healthcare System, West Haven, Connecticut (Drs Krystal, Petrakis, and Yoon); Behavioral Health Services, Yale-New Haven Hospital, New Haven, Connecticut (Drs Krystal, Petrakis, and Yoon); Olin Center for Neuropsychiatry Research, Institute of Living, Hartford, Connecticut (Dr Pearlson)
| | - Stephanie O’Malley
- Departments of Psychiatry and Neuroscience, Yale University School of Medicine, New Haven, Connecticut (Drs Krystal, Petrakis, O’Malley, Krishnan-Sarin, Pearlson, and Yoon); Psychiatry Services, VA Connecticut Healthcare System, West Haven, Connecticut (Drs Krystal, Petrakis, and Yoon); Behavioral Health Services, Yale-New Haven Hospital, New Haven, Connecticut (Drs Krystal, Petrakis, and Yoon); Olin Center for Neuropsychiatry Research, Institute of Living, Hartford, Connecticut (Dr Pearlson)
| | - Suchitra Krishnan-Sarin
- Departments of Psychiatry and Neuroscience, Yale University School of Medicine, New Haven, Connecticut (Drs Krystal, Petrakis, O’Malley, Krishnan-Sarin, Pearlson, and Yoon); Psychiatry Services, VA Connecticut Healthcare System, West Haven, Connecticut (Drs Krystal, Petrakis, and Yoon); Behavioral Health Services, Yale-New Haven Hospital, New Haven, Connecticut (Drs Krystal, Petrakis, and Yoon); Olin Center for Neuropsychiatry Research, Institute of Living, Hartford, Connecticut (Dr Pearlson)
| | - Godfrey Pearlson
- Departments of Psychiatry and Neuroscience, Yale University School of Medicine, New Haven, Connecticut (Drs Krystal, Petrakis, O’Malley, Krishnan-Sarin, Pearlson, and Yoon); Psychiatry Services, VA Connecticut Healthcare System, West Haven, Connecticut (Drs Krystal, Petrakis, and Yoon); Behavioral Health Services, Yale-New Haven Hospital, New Haven, Connecticut (Drs Krystal, Petrakis, and Yoon); Olin Center for Neuropsychiatry Research, Institute of Living, Hartford, Connecticut (Dr Pearlson)
| | - Gihyun Yoon
- Departments of Psychiatry and Neuroscience, Yale University School of Medicine, New Haven, Connecticut (Drs Krystal, Petrakis, O’Malley, Krishnan-Sarin, Pearlson, and Yoon); Psychiatry Services, VA Connecticut Healthcare System, West Haven, Connecticut (Drs Krystal, Petrakis, and Yoon); Behavioral Health Services, Yale-New Haven Hospital, New Haven, Connecticut (Drs Krystal, Petrakis, and Yoon); Olin Center for Neuropsychiatry Research, Institute of Living, Hartford, Connecticut (Dr Pearlson)
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Chung E, Ohgami Y, Quock RM. Increasing the availability of l-arginine and nitric oxide increases sensitivity of nitrous oxide (N2O)-insensitive inbred mice to N2O-induced antinociception. Brain Res Bull 2016; 125:218-21. [PMID: 27496065 DOI: 10.1016/j.brainresbull.2016.08.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 07/20/2016] [Accepted: 08/01/2016] [Indexed: 10/21/2022]
Abstract
Nitrous oxide (N2O)-induced antinociception in mice is dependent on the neuromodulator nitric oxide (NO). In contrast to C57BL/6J (B6) mice, DBA/2J (D2) mice fail to respond to N2O with a robust antinociceptive response or with an increase in brain nitric oxide synthase (NOS) enzyme activity, suggesting that failure of D2 mice to respond to N2O might result from a deficit of NO function. Therefore, it was of interest to determine whether increasing the availability of NO might increase sensitivity of D2 mice to N2O. Male D2 mice were pretreated with sub-antinociceptive intracerebroventricular doses of the NO donor 3-morpholinosydnoimine or the NO precursor l-arginine then assessed for responsiveness to N2O-induced antinociception using the acetic acid abdominal constriction test. Both pretreatments increased the antinociceptive responsiveness of D2 mice to N2O. These results indicate that the NOS enzyme in D2 mice is functional and that the deficit in NO function that obstructs sensitivity to N2O-induced antinociception may lie in availability or utilization of l-arginine.
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Affiliation(s)
- Eunhee Chung
- Department of Pharmaceutical Sciences, College of Pharmacy, Washington State University, Pullman, WA 99164, United States
| | - Yusuke Ohgami
- Department of Pharmaceutical Sciences, College of Pharmacy, Washington State University, Pullman, WA 99164, United States
| | - Raymond M Quock
- Department of Pharmaceutical Sciences, College of Pharmacy, Washington State University, Pullman, WA 99164, United States.
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