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Nitrous Oxide during Labor: What Matters, Analgesic Effectiveness or Patient Satisfaction?
Abstract Number: O2-04
Abstract Type: Original Research
Studies of patient satisfaction and analgesic effectiveness with nitrous oxide (N2O) during labor are limited. While N2O appears less effective than neuraxial analgesia,[1,2] N2O remains a popular choice for many parturients. We sought to compare the relationship between analgesic effectiveness and patient satisfaction with analgesia in women who delivered vaginally using neuraxial analgesia, N2O, or N2O followed by neuraxial analgesia.
A standardized survey was recorded on the first postpartum day for all women who received anesthetic care. Data were queried for women who delivered vaginally with N2O and/or neuraxial labor analgesia over a 34-month period in 2011-14. Parturients with complete data for analgesia quality and patient satisfaction were included. Analgesia and satisfaction scores were compared using logistic regression for three groups: N2O, neuraxial analgesia, or both.
6506 women received anesthesia and delivered vaginally. Complete data were available for 6243 (96%) women. Of these, 5103 (82%) chose neuraxial analgesia and 1140 (18%) chose N2O. Of the latter, 461 (40%) switched to neuraxial analgesia after first receiving N2O. These patients mirrored the neuraxial-only group in analgesia quality and patient satisfaction. Analgesia and satisfaction scores for all three groups are shown in the figure. Among women who reported poor analgesia (0-4; n=258), those who received N2O alone were more likely to report high satisfaction (8-10) than women who received neuraxial analgesia alone (OR 2.6, 95%CI 1.5-4.6, P=0.001). Among those who reported a high analgesia score (8-10, n=5451), odds of patient satisfaction were uniformly high in all three groups (P>0.05).
Patients who received N2O alone were as likely to express satisfaction with anesthesia care as those who received neuraxial analgesia, even though they were less likely to have analgesia with excellent effectiveness. While pain relief contributes to satisfaction with labor analgesia care, our results suggest that other factors are also important.[2-4] Whether this reflects different patient expectations/goals, preservation of patient autonomy, and/or other factors remains to be determined.
Liskis F. Anesth Analg 2014;118:153
Waldenstrom U. Obstet Gynaecol 2006;27:147
King T. Anesth Analg 2014;118:12
Angle P. Can J Anesth 2010;57:468