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The Effect of Nitrous Oxide Anesthesia on Early Postoperative Opioid Consumption and Pain
  1. Andreas Duma, MD*,†,
  2. Daniel Helsten, MD*,
  3. Frank Brown, BS*,
  4. Michael M. Bottros, MD* and
  5. Peter Nagele, MD, MSc*
  1. *Department of Anesthesiology, Washington University in St Louis, St Louis, MO
  2. †Department of Anesthesiology and General Intensive Care, Medical University of Vienna, Vienna, Austria
  1. Address correspondence to: Peter Nagele, MD, MSc, Division of Clinical and Translational Research, Department of Anesthesiology, Washington University School of Medicine, 660 S Euclid Ave, Box 8054, St Louis, MO 63110 (e-mail: nagelep{at}wustl.edu).

Abstract

Background and Objectives Many patients experience moderate to severe postoperative pain. Nitrous oxide (N2O) exerts analgesia by inhibition of N-methyl-D-aspartate receptors. Ketamine, another N-methyl-D-aspartate receptor antagonist, reduces postoperative opioid consumption and pain. A similar effect of N2O is plausible, yet understudied. The goal of this study was to determine the effects of N2O anesthesia on early postsurgical opioid consumption and pain.

Methods This was a retrospective, secondary analysis of the Vitamins In Nitrous Oxide trial, where 500 patients undergoing general anesthesia for noncardiac surgery received 60% N2O and 125 received no N2O (otherwise, inclusion/exclusion criteria were identical). Exclusion criteria for this study were regional anesthesia, not extubated after surgery, transfer to intensive care unit, no available postanesthesia care unit record, postsurgical sedation, or treated with naloxone. Primary outcomes were cumulative opioid consumption measured in morphine equivalents and pain scores during the immediate recovery phase.

Results Four hundred forty-two patients met inclusion criteria. No difference in intraoperative and postoperative opioid consumption was observed between patients who received N2O (n = 353) and patients who did not (n = 89). The median [interquartile range] postoperative morphine equivalent dose was 6.7 mg [1.7–14.1 mg] for patients who received N2O and 6.7 mg [2.1–15.4 mg] for patients who did not (P = 0.73). The maximum pain score was 6 [4–8] for patients who received N2O versus 6 [3–8] for patients who received N2O-free anesthesia (P = 0.52). The prevalence of moderate to severe pain was 69% for patients who received N2O and 68% for patients who did not (P = 0.90).

Conclusions Nitrous oxide anesthesia was not associated with decreased opioid administration, pain, or incidence of moderate to severe pain in the early postoperative phase.

https://doi.org/10.1097/AAP.0000000000000039

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    Footnotes

    • Dr Nagele reports receiving research support from Roche Diagnostics (Indianapolis, IN). Dr Duma reports receiving a fellowship grant from the Max Kade Foundation (New York City, NY). For the remaining authors, no potential conflicts of interest or sources of funding are declared.

      Supported, in parts, by grants from the National Institutes of Health, Bethesda, MD (NIHK23 GM087534 to PN and UL1RR024992 to Washington University Institute of Clinical and Translational Sciences), the Foundation for Anesthesia Education and Research (FAER), and the Division of Clinical and Translational Research, Department of Anesthesiology, Washington University.

      The work should be attributed to the Department of Anesthesiology, Washington University in St Louis, St Louis, MO.