School of Nursing, Weifang Medical University, Weifang, China.
Department of Stomatology, The 960th Hospital of People's Liberation Army of China (PLA), Jinan, China.
PLoS One. 2023 Jun 6;18(6):e0286713. doi: 10.1371/journal.pone.0286713. eCollection 2023.
Nitrous oxide (N2O) with rapid analgesic effect is often used to relieve pain induced by diagnostic procedures. This review was conducted to evaluate the efficacy and safety of N2O in patients undergoing puncture biopsy.
We systematically searched PubMed, Embase, the Cochrane Library, Web of Science, Scopus and the ClinicalTrials.gov up to March, 2022. Randomized controlled trials (RCTs) were included if they investigated the effect of N2O in adults undergoing puncture biopsy. The primary outcome was pain score. Secondary outcomes included anxiety score, patient satisfaction and side effects.
Twelve RCTs with 1070 patients were included in the qualitative review, of which eleven RCTs were included in the meta-analysis. Pooled analysis suggested that compared with the controls (placebo, lidocaine and midazolam), N2O had better analgesic effect (MD -1.12, 95% CI -2.12 to -0.13, P = 0.03; I2 = 94%). In addition, N2O significantly alleviated patient anxiety (MD = -1.79, 95% CI -2.41 to -1.18, P<0.00001; I2 = 0%) and improved patient satisfaction (MD 1.81, 95% CI 0.11 to 3.50, P = 0.04; I2 = 92%). There was no significant difference regrading the risk of nausea (RR 2.56; 95% CI 0.70 to 9.31, P = 0.15; I2 = 0%), headache (RR 0.62, 95% CI 0.17 to 2.33, P = 0.48; I2 = 46%), dizziness (RR 1.80, 95% CI 0.63 to 5.13, P = 0.27; I2 = 0%) or euphoria (RR 2.67, 95% CI 0.81 to 8.79, P = 0.11; I2 = 8%) between the N2O group and the control group.
The present review suggested that N2O might be effective for pain management in patients undergoing puncture biopsy.
氧化亚氮（N2O）具有快速镇痛作用，常被用于缓解诊断性操作引起的疼痛。本综述旨在评估 N2O 用于接受穿刺活检患者的疗效和安全性。
我们系统地检索了 PubMed、Embase、Cochrane 图书馆、Web of Science、Scopus 和 ClinicalTrials.gov，检索时间截至 2022 年 3 月。纳入了评估 N2O 对接受穿刺活检的成年人影响的随机对照试验（RCT）。主要结局为疼痛评分。次要结局包括焦虑评分、患者满意度和不良反应。
12 项 RCT 共纳入 1070 例患者，其中 11 项 RCT 纳入了荟萃分析。汇总分析提示，与对照组（安慰剂、利多卡因和咪达唑仑）相比，N2O 具有更好的镇痛效果（MD-1.12，95%CI-2.12 至-0.13，P=0.03；I2=94%）。此外，N2O 可显著减轻患者的焦虑（MD=-1.79，95%CI-2.41 至-1.18，P<0.00001；I2=0%），并提高患者满意度（MD 1.81，95%CI 0.11 至 3.50，P=0.04；I2=92%）。两组间恶心（RR 2.56；95%CI 0.70 至 9.31，P=0.15；I2=0%）、头痛（RR 0.62，95%CI 0.17 至 2.33，P=0.48；I2=46%）、头晕（RR 1.80，95%CI 0.63 至 5.13，P=0.27；I2=0%）或欣快（RR 2.67，95%CI 0.81 至 8.79，P=0.11；I2=8%）的风险无显著差异。
本综述提示 N2O 可能对接受穿刺活检患者的疼痛管理有效。
