St. Louis, Jan. 7, 2001--To young children and their parents, a trip to the emergency room for stitches can mean not only the pain of an injury but also anxiety about the procedure.
In a new study, researchers at Washington University School of Medicine in St. Louis determined that nitrous oxide (laughing gas) is more effective in sedating young children during facial suturing than the more traditional use of an oral pain medication. The study, which appears in the January issue of Annals of Emergency Medicine, examined 204 children ages 2 to 6. Lacerations requiring sutures contribute to as many as half of emergency department visits by injured children.
"The nitrous oxide worked very well at reducing anxiety in the age group we studied," said Jan D. Luhmann, M.D., assistant professor of pediatrics in the Division of Emergency Medicine at the School of Medicine and St. Louis Children's Hospital. "Prior to this study, nitrous oxide had not been commonly used in pediatric emergency units. We knew of its widespread and successful use by dentists in the outpatient setting, so we postulated that it would work well in our setting, too." Luhmann said the method also showed fewer side effects such as irritability and dizziness and reduced recovery time from approximately an hour to under 5 minutes when compared to the oral pain medication midazolam.
Children ranging in age from 2 to 6 received one of four different kinds of care: 1) standard care, which included comforting and topical anesthesia augmented with injected lidocaine if needed; 2) standard care and oral midazolam; 3) standard care and nitrous oxide; or 4) standard care, oral midazolam and nitrous oxide. Videotapes of the procedures were blindly scored using the Observational Scale of Behavioral Distress-Revised to assess distress at the beginning of the procedure and during wound cleaning, lidocaine injecting, suturing and recovery. The doctors who inserted the sutures and were blinded to the method of sedation administered to their patients noted adverse effects. Parents also completed questionnaires.
Both the parents and physicians scored the use of standard care combined with nitrous oxide as the highest of all the care methods in reducing pain and anxiety. The standard care, oral midazolam and nitrous oxide method ranked second
In a related editorial, Baruch S. Krauss, M.D., of the Children's Hospital emergency department in Boston indicates the study succeeded in demonstrating that nitrous oxide meets most of the characteristics necessary for an ideal procedure of this kind. However, he also indicates that a larger sample size is needed to reliably profile the incidence and severity of adverse events.
The full-time and volunteer faculty of Washington University School of Medicine are the physicians and surgeons of Barnes-Jewish and St. Louis Children's hospitals. The School of Medicine is one of the leading medical research, teaching and patient care institutions in the nation. Through its affiliations with Barnes-Jewish and St. Louis Children's hospitals, the School of Medicine is linked to BJC HealthCare.