Does nitrous oxide labor analgesia influence the pattern of neuraxial analgesia usage? An impact study at an academic medical center

Abstract

Study objective: To compare the rate of epidural use before and after the implementation of nitrous oxide (N₂O).

Design: Data were obtained from a nursing database of N₂O usage and our obstetric anesthesia database. We compared 8 months before and 8 months after the introduction of N₂O. It was available 24 h/d, 7 d/wk, consistent with neuraxial analgesia availability. Epidural utilization before and after introduction of N₂O was compared using χ² analysis.

Setting: Labor and delivery floor.

Main results: Total number of births over the study period was 8539: 4315 pre-N2O and 4224 post-N₂O. The rate of epidural usage was 77% pre-N₂O and 74% after N₂O (P= not significant, χ²). A total of 762 patients used N₂O. Monthly analysis showed no change in pattern of neuraxial analgesia use in post-N₂O period compared with the pre-N₂O period.

Conclusion: The introduction of N₂O for labor analgesia was not associated with any change in our rate of labor epidural utilization. Under the conditions of our study, these results suggest that N₂O does not discourage neuraxial use for labor pain relief.

Keywords: Neuraxial analgesia; Nitrous oxide.