Nitrous Oxide Analgesia During Intra-Articular Injection for Juvenile Idiopathic Arthritis

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NITROUS OXIDE ANALGESIA DURING INTRA-ARTICULAR

INJECTION FOR JUVENILE IDIOPATHIC ARTHRITIS

Background: Intra-articular injection of corticosteroid is a safe and

effective treatment for children with juvenile idiopathic arthritis (JIA).

To facilitate and to maximise the efficacy of the procedure patient

compliance is essential, and in certain cases requires use of general

anaesthesia. There is interest in the use of conscious sedation with nitrous

oxide during intra-articular steroid injection, but to date there is little

data concerning its efficacy in this context.

Objectives: To evaluate the efficacy and safety of nitrous

oxide-oxygen for children with JIA undergoing intra-articular corticosteroid

injection.

Methods: A prospective observational study in two centres providing

tertiary paediatric rheumatology care in the North West of the United

Kingdom. 55 children with JIA who had intra-articular injection completed a

0-10cm visual analogue pain score (VAS) immediately after the procedure. The

nurse supervising the administration of nitrous oxide and also the parent

recorded a pain score on the same scale. The main outcome measure was

comparison of patient, parent and nurse pain score.

Results: A total of 70 joints were injected in 55 patients. The median

age was 13.54 years. The median pain score for patient, nurse and parent was

1 (0-10cm VAS). The mean rank patient score was 2.12, which was greater than

the nurse score (1.97), which was greater than the parent score (1.91).

These differences were significant. There were no serious adverse

events in any patient.

Conclusion: Nitrous oxide-oxygen provides safe and effective analgesia

for intra-articular injection in children. In some cases, nurses and parents

underestimated pain related to the procedure compared to the child.

A.G. Cleary 1, A.V. Ramanan 2, E. Baildam 2, A. Birch 3, J.A. Sills 3,

J.E. son 3 1Paediatric Rheumatology, Royal Liverpool Children's

Hospital, Liverpool, United Kingdom, 2Paediatric Rheumatology, Royal

Manchester Children's Hospital, Manchester, 3Paediatric Rheumatology, Royal

Liverpool Children's Hospital, Liverpool, UK