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Nitrous Oxide Administered by the Plastic Surgeon for Repair of Facial Lacerations in Children in the Emergency Room

Bar-Meir, Eran M.D.; Zaslansky, Ruth D.Sc.; Regev, Eli M.D.; Keidan, Ilan M.D.; Orenstein, Arie M.D.; Winkler, Eyal M.D.

Plastic and Reconstructive Surgery: April 15th, 2006 - Volume 117 - Issue 5 - p 1571-1575
doi: 10.1097/01.prs.0000206298.71083.df
Reconstructive: Head and Neck: Original Articles

Background: The purpose of this study was to investigate a means of providing pain relief during repair of facial lacerations in children in the emergency room.

Methods: This study was conducted in the emergency room of a tertiary care, university-affiliated hospital. Fifty percent nitrous oxide was administered by the surgeon who sutured the laceration. A nurse monitored the child throughout the procedure. At the end of the procedure, pain scores were evaluated by the surgeon and nurse using the FLACC (face, legs, activity, cry, and consolability) scale, a structured observational-behavioral scale for measurement of pain.

Results: Sixty patients between the ages of 1 and 16 years participated in the study. Of these, 15 were sutured using standard care (lidocaine infiltration), and 45 children received nitrous oxide in addition to lidocaine infiltration. Nitrous oxide was administered for an average of 11.9 ± 5.1 minutes (range, 4 to 30 minutes). Forty-three children recovered to preprocedure activity in less than 1 minute. Two children recovered in less than 3 minutes. Average FLACC scores during infiltration and suturing were significantly lower in the nitrous oxide group compared with controls (infiltration, 1.9 of 10 versus 9.7 of 10; suturing, 2 of 10 versus 8.8 of 10). Forceful restraining was necessary in all the controls, whereas in the nitrous oxide group mild force was required in only 15 percent. Seventy percent of the children receiving nitrous oxide had no side effects. Vomiting and nausea were the most common (17 percent), transient side effects. No respiratory or cardiovascular side effects occurred.

Conclusions: Nitrous oxide can be safely administered by plastic surgeons while suturing facial lacerations in the emergency room. The fast onset and rapid recovery characteristics of nitrous oxide provide a convenient environment for performing short surgical procedures. This safe method for provision of analgesia and anxiolysis may be appealing to plastic surgeons for ambulatory procedures (e.g., suture removal, expander inflation, Botox injection, injection of various fillers) in pediatric and adult populations.

Tel-Aviv, Israel

From the Departments of Plastic and Reconstructive Surgery and Anesthesia and Intensive Care and the Unit of Pediatric Anesthesia, Chaim Sheba Medical Center, Tel Hashomer, affiliated with the Sackler Faculty of Medicine, Tel-Aviv University.

Received for publication November 23, 2004; revised February 11, 2005.

The first two authors contributed equally to the article.

Eran Bar-Meir, M.D., Department of Plastic and Reconstructive Surgery, Chaim Sheba Medical Center, P.O.B. 5345, Kfar Maas 49925, Israel,

©2006American Society of Plastic Surgeons