ABSTRACT
Study Objective
: To evaluate the impact of nitrous oxide on patient-reported pain for placement of
intrauterine systems (IUSs) in adolescents
Study Design
: Prospective observational study
Setting
: IUS placement in an ambulatory clinic compared with placement with nitrous oxide
in a hospital-based sedation unit
Participants
: English-speaking adolescents aged 12 to 20 presenting to a pediatric and adolescent
gynecologist with a medical indication for IUS placement
Main Outcome Measures
: Patient-reported procedural pain measured on a visual analog scale 2 minutes post
IUS insertion procedure. Secondary outcome measurement of likelihood of recommending
an IUS to a peer.
Results
: Seventy-four patients agreed to participate. Forty-five patients underwent IUS placement
in the clinic. Controlling for age, history of dysmenorrhea, and body mass index,
a significant time (change in reported pain scores pre- vs post IUS insertion) by
treatment (nitrous oxide vs standard of care) interaction was observed for patient-reported
pain (b = –29.32 mm, P < 0.01). Patients receiving nitrous oxide were more likely to recommend an intrauterine
placement than patients who received the current standard of care for pain management
(b = 0.47, P = 0.02) after controlling for age, baseline pain score, and dysmenorrhea history.
Conclusion
: Patient-reported pain was attenuated for patients who received nitrous oxide relative
to those who received standard IUS placement. Patient-reported satisfaction was higher
for patients who received nitrous oxide relative to those who received standard IUS
placement.
Key Words
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Article info
Publication history
Published online: November 05, 2021
Accepted:
October 25,
2021
Received in revised form:
October 6,
2021
Received:
July 28,
2021
Identification
Copyright
© 2021 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.
