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Nitrous Oxide for Labor Analgesia and Maternal Coping Ability
Abstract Number: T4B-5
Abstract Type: Original Research
Background: Recently, there has been increased interest in the use of nitrous oxide for labor analgesia. Although it provides less effective pain relief than epidural anesthesia, prior studies have demonstrated that parturients receiving only nitrous oxide were as likely as those receiving neuraxial analgesia to report high maternal satisfaction. The dissociation between maternal satisfaction and effective labor analgesia suggests the benefits of nitrous oxide may be independent of nociceptive pathways. Nitrous oxide may contribute to increased maternal satisfaction during labor by improving coping ability. Commonly employed pain scores provide a numeric assessment of pain but can fail to capture how women are coping with the peripartum experience. A Labor and Delivery Coping Scale may better describe the effectiveness of interventions in improving maternal coping ability. This study investigates the association between the use of nitrous oxide and the temporal course of maternal coping ability during labor, compared with neuraxial analgesia.
Methods: This retrospective cohort study included laboring parturients ≥18 years of age admitted to our institution planning vaginal delivery. Exclusion criteria were age <18 and planned cesarean delivery. Parturients were divided into two groups based on exposure to nitrous oxide during labor. The nitrous oxide group was further stratified based on the placement of a labor epidural following nitrous oxide exposure. The primary endpoint was the longitudinal change in mean coping score from baseline before and after either nitrous oxide initiation or epidural placement. Secondary endpoints include change in visual analog pain score after intervention, cumulative fentanyl equivalents use, and overall maternal satisfaction with labor analgesia.
Results: The study cohort included 738 eligible parturients. The mean age was 30.5 ± 5.5 years, mean BMI was 32 ± 7. A total of 624 had a vaginal delivery, 114 required cesarean delivery, and 8 received general anesthesia. An epidural was placed in 542 patients (73%), and a spinal was used in 16 patients (2%). One hundred eleven (15%) received nitrous oxide during labor. The average duration of nitrous oxide exposure was 240 ± 396 min. Among those who used nitrous oxide, 72 (65%) parturients later received neuraxial labor analgesia and 39 (35%) parturients received nitrous oxide alone.
Conclusions: A large proportion of laboring women receiving nitrous oxide for labor converted to neuraxial labor analgesia. Coping scores and factors associated with conversion to another analgesic modality will be further investigated.
King T, Wong C. Nitrous Oxide for Labor Pain: Is it a Laughing Matter? Anesth Analg (2014)118:12-14.
Likis F etal. Nitrous Oxide for the Management of Labor Pain: A Systematic Review. Anesth Analg (2014)118:153-67.
Lopez B etal. Maternal Satisfaction Does Not Depend Exclusively on Analgesic Effectiveness. Anesth Analg (2017)124:548-53.