Adjunctive Nitrous Oxide During ED Incision and Drainage of Abscess
Status:
Terminated
Trial end date:
2021-04-01
Target enrollment:
Participant gender:
Summary
This study aims to describe the safety and efficacy of adjunctive nitrous oxide to lidocaine
anesthesia in decreasing pain in adults during incision and drainage (I&D) of cutaneous
abscesses in the emergency department (ED). Incision and drainage has been considered one of
the more painful procedures performed in the ED. Standard care recommends a minimum of local
anesthesia, however, there is no consensus on the appropriateness of pain management during
ED painful procedures, such as incision and drainage. Oligoanalgesia continues to be a
problem for ED health care providers. Despite extensive research in mechanisms of pain,
factors relating to inadequate pain management, and evidence-based pain management
strategies, implementation of effective pain management in the ED is still lacking. Nitrous
oxide is a weak sedative agent with analgesic and anxiolytic properties. Rapid onset and
short duration of action, ease of use, and favorable cardio-respiratory profile makes it an
ideal agent for analgesia in the ED and may provide a novel strategy for pain management in
I&D. While it has been studied an adjunct to laceration repair in children and labor in
women, the use in the ED setting is not known. Adult patients capable of consenting, with
simple cutaneous abscess requiring incision and drainage are the targeted population.
Eligible patients who consent to the study will be randomized to one of two groups: nitrous
oxide/local anesthesia or oxygen/local anesthesia. Primary endpoints assessed will be pain
scores using the VAS at baseline, ten minutes after NO administration, immediately post I&D
procedure, and ten minutes after procedure completion. Additionally, secondary endpoints of
patient and physician procedure satisfaction scores, total time of nitrous oxide used, and
presence of adverse events, including respiratory depression defined by peripheral SaO2 below
92%, ETCO2 level above 50, a rise or decrease of 10% above or below baseline, the loss of the
ETCO2 waveform for more than 15 seconds. The vital signs, medical conditions, demographics,
and abscess dimensions will also be collected.