Nitrous Oxide sedation for intra-articular injection in juvenile idiopathic arthritis

To prospectively evaluate the effectiveness and safety of NO analgesia for intra-articular corticosteroid injection in JIA, and to assess patients and staff satisfaction with the treatment.NO was administered to JIA patients scheduled for joint injection. The patient, parent, physician and nurse completed visual-analog scores (VAS) (0–10) for pain, and a 5-point satisfaction scale. Change in heart rate (HR) during the procedure was recorded in order to examine physiologic response to pain and stress. Patient's behavior and adverse reactions were recorded.54 procedures (72 joints) were performed, 41 females, 13 males; 39 Jewish, 13 Arab; mean age was 12.2 ± 4.7 year. The median VAS pain score for patients, parents, physicians and nurses was 3. The HR increased ≥ 15% in 10 patients. They had higher VAS scores as evaluated by the staff. The median satisfaction level of the parents and staff was 3.0 and 5.0 respectively. Adverse reactions were mild.NO provides effective and safe sedation for JIA children undergoing intra-articular injections.Intra-articular corticosteroid injection is one of the cornerstones of treatment for children with juvenile idiopathic arthritis (JIA), particularly oligoarthritis [1]. Major side effects are few except for the pain and the anxiety that accompanies the procedure.Several techniques are used in an effort to reduce pain including conscious sedation using intravenous benzodiazepine or general anesthesia [2]. Recently the use of nitrous oxide (NO) as a safe and effective sedation method has been reported [3-6]. NO is a volatile gas with analgesic, anxiolytic and sedative properties, mixed together with oxygen. NO has been used for more than 200 years [7].Few studies have reported on the safety and efficacy of NO in JIA. Cleary et al, showed that a fixed mixture of oxygen and NO, given using a self-delivery device was safe and effective for intra-articular injection in JIA [8].Using NO by continuous flow method facilitates its' use in you