A Before-and-After Study to Assess Pain Management by Nitrous Oxide in Renal Colic Patients: The NEPHROPAIN Study

François Jean Hugo SAGET

Resumen


Background and Importance: Renal Colic is a common pathology in emergency departments. It provokes severe pain requiring analgesic treatment from the stage of suspicion. The most effective treatment consists of non-steroidal anti-inflammatory drugs with a significant delay in action. Evaluating other therapies that can improve the analgesic management of patients with minimal risk is essential.        

Objective: The objective of Nephropain was to determine whether Nitrous Oxide effectively reduces pain in patients suspected of having renal colic.

Methods : NEPHROPAIN is an interventional prospective Before-and-After study conducted at the Emergency Department of the Rennes University Hospital. The Before Phase (Without Nitrous Oxide treatment) took place from May to August 2016. The after phase (Nitrous Oxide or N2O) went from October 2018 to May 2019. Adult individuals with suspected renal colic represented the study population. Patients in the non-Nitrous Oxide phase (Non-N2O) received usual analgesics, while patients in the Nitrous Oxide phase also received Nitrous Oxide inhalation.The primary endpoint was the proportion of individuals whose initial Numerical pain rating scale (NRS) was divided by two after 20 minutes from the start of pain management.  

Results: In total, 120 patients were included in the study. The mean baseline NRS was 7.8 in patients in the N2O phase, which was significantly higher than in the Non-N2O group (p=0.048). The NRS at 20 minutes was divided by 2 for 70% of patients in the N2O phase, compared to 47% in the non-N2O phase (p=0.01). Nitrous Oxide did not reduce the use of other analgesics: 67% of patients in the N2O phase received an analgesic between 20 and 240 minutes following care, contrasting with 55% in the non-N2O phase (p=0.19).

Conclusions: Our study demonstrated the probable efficacy of Nitrous Oxide in the emergency management of renal colic pain.


Palabras Clave


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