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PReS-FINAL-2101: Nitrous oxide analgesia for intra-articular injection in juvenile idiopathic arthritis: our experience


Nitrous Oxide (NO), known as ''laughing gas'', is a volatile gas with analgesic, anxiolytic and sedative properties, used for treatment of short-lived mild or moderate pain.


To evaluate the efficacy and safety of nitrous oxide-oxygen for children with juvenile idiopathic arthritis (JIA) undergoing intra-articular corticosteroid injection.


A 50:50 mixture with NO and oxygen was administered to JIA patients over the age of 5 years scheduled for joint injection. In some cases additional sedative agents (local EMLA, orally midazolam, nasal fentanest) was administered. Every patient completed visual-analogue scores (VAS) (0-10) for pain immediately after the procedure, and after 30 and 60 minutes. The physician valuated sedation level according to Ramsay scale and memory level of the procedure.


A total of 31 joints were injected in 25 patients (23 F, 2 M, median age 10.4 years). EMLA was placed in all patients at least one hour before the procedure. 19/25 patients received oral midazolam (0.5 mg/kg) 30 minutes before the intra-articular injection. 1/25 patients received nasal fentanest (75γ) during the procedure. The median pain score for patient (0-10 cm VAS) was 0.7 immediately after the procedure, 0.6 after 30 minutes, and 0.5 after 60 minutes. Only 3 out of 25 patients remembered the procedure. There were no adverse events in any patient.


Nitrous oxide-oxygen provides safe and effective analgesia for JIA children undergoing intra-articular injections, avoiding intravenous cannulation and general anaesthesia.

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This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.

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Pastore, S., Moressa, V., Gortani, G. et al. PReS-FINAL-2101: Nitrous oxide analgesia for intra-articular injection in juvenile idiopathic arthritis: our experience. Pediatr Rheumatol 11 (Suppl 2), P113 (2013).

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