Nitrous Oxide Effect on Relieving Anxiety and Pain in Parturients Under Spinal Anesthesia for Caesarean Section

BACKGROUND: Anxiety is an unpleasant experience that may have adverse effects on the process of anesthesia, cesarean delivery, recovery period and postoperative pain. Anxiety can also affect maternal satisfaction of the medical cares that provided by the medical team. OBJECTIVES: To compare the effects of inhalational 50% nitrous oxide (N(2)O) with oxygen on reducing anxiety and pain in parturients who have undergone caesarean section under spinal anesthesia. PATIENTS AND METHODS: In this double-blind clinical trial, 56 primigravid parturients were randomly assigned into two groups according to the operating list schedule. The experimental group received inhalational 50% N(2)O three minutes before spinal anesthesia to the end of delivery. The control group received only oxygen. Flow meters were covered by a dark shield and monitored by an experienced nurse anesthetist. Pain and anxiety of patients were measured using visual analogue scale (VAS) by another nurse who was neither involved in the anesthetic process nor aware of the participants' allocation and inhalation agents. Data regarding sedation level, ephedrine use, nausea, vomiting, and neonate Apgar score were recorded as well. RESULTS: Overall mean ± SD of anxiety VAS scores was 1.77 ± 1.5 in the experimental group and 3.12 ± 1.73 in the control groups (P = 0.003). The mean ± SD of pain VAS scores of the experimental and control groups were 0.82 ± 1.5 and 1.64 ± 1.45, respectively (P = 0.042). No significant differences were seen regarding blood oxygen saturation, neonate Apgar scores, total used ephedrine, operation time, delivery time, nausea, and vomiting between the two studied groups. CONCLUSIONS: Inhalation of 50% N(2)O can significantly decrease anxiety (without clinically significant side effects) compared with O(2) inhalation in parturients who have undergone caesarean section under spinal anesthesia.