Nitrous Oxide for Procedural Pain

(SANO-VAS Trial)

Overseen By Michelle Shabo, MD

Age: 18+

Sex: Male

Trial Phase: Phase 4

Sponsor: Beth Israel Deaconess Medical Center

Must not be taking: Benzodiazepines, Opioids

Disqualifiers: Cognitive impairment, Severe B-12 deficiency, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Prior Safety Data This treatment has passed at least one previous human trial

Approved in 3 Jurisdictions This treatment is already approved in other countries

Compensation: Varies

Number of Visits: 4

Duration: 1 day

35 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial tests whether nitrous oxide (also known as laughing gas or N2O) can reduce pain and anxiety during vasectomies. It also examines whether patients feel more satisfied when they control their own nitrous oxide levels during the procedure. The goal is to determine if this self-adjusted approach enhances the overall experience. Men scheduled for a vasectomy who do not use certain medications and do not have specific medical conditions might be suitable candidates for this study. As a Phase 4 trial, this research aims to understand how this already FDA-approved and effective treatment can benefit more patients.

Do I have to stop taking my current medications for the trial?

The trial protocol does not specify if you need to stop taking your current medications. However, you cannot use benzodiazepines or opioids 'as needed' for the vasectomy.

What is the safety track record for nitrous oxide?

Research has shown that nitrous oxide, or "laughing gas," is generally safe for pain relief during procedures. Studies have found it to be well-tolerated, with most side effects being mild and temporary. Some individuals might experience slight dizziness or a headache, but these effects typically resolve quickly.

Nitrous oxide is already widely used in dental work and childbirth, supporting its safety for other applications. It is important to note that while nitrous oxide can induce relaxation, it does not cause sleep, allowing users to remain awake and aware.

In this study, patients will control their own level of nitrous oxide during a vasectomy. This approach helps ensure comfort while maintaining safety. Overall, nitrous oxide appears to be a safe option for managing pain and anxiety during minor procedures. ^{1 2 3 4 5}

Why are researchers enthusiastic about this study treatment?

Researchers are excited about using nitrous oxide for procedural pain during vasectomies because it offers a unique, self-adjusted method of sedation. Unlike traditional pain management options, which often involve oral or injected medications, nitrous oxide allows patients to control their level of sedation, providing a more personalized experience. This approach can minimize the risk of over-sedation and potentially reduce recovery time, making it an appealing alternative for both patients and healthcare providers. Nitrous oxide also acts quickly and is rapidly cleared from the body, which can lead to a faster return to normal activities post-procedure.

What evidence suggests that nitrous oxide is effective for reducing pain and anxiety during vasectomy?

Research shows that nitrous oxide, commonly known as "laughing gas," can effectively reduce pain and anxiety during medical procedures. Previous studies found nitrous oxide to be as effective as other sedatives for pain relief in minor surgeries. It also helps patients feel more relaxed and less worried. Specifically, for urology procedures, nitrous oxide significantly improved pain and anxiety compared to other options. In this trial, participants will receive self-adjusted nitrous oxide (SANO) at concentrations of minimal sedation (0-50%) throughout vasectomy. These findings suggest that nitrous oxide could enhance the experience for patients undergoing a vasectomy by reducing discomfort and stress. ^{4 6 7 8 9}

Who Is on the Research Team?

Heidi Rayala, MD, PhD

Principal Investigator

Beth Israel Deaconess Medical Center

Marissa Kent, MD

Principal Investigator

Beth Israel Deaconess Medical Center

Peter Steinberg, MD

Principal Investigator

Beth Israel Deaconess Medical Center

Are You a Good Fit for This Trial?

This trial is for men aged 21 to 85 scheduled for a vasectomy, who can use email and a computer, and are suitable for inhaling nitrous oxide/oxygen. It's not for those using benzodiazepines or opioids around the time of surgery, with facial hair affecting mask seal, cognitive issues preventing survey completion, or specific recent surgeries or medical conditions.

Inclusion Criteria

Scheduled for vasectomy

Access to an email and computer

You must be between 21 and 85 years old.

Exclusion Criteria

You plan to use benzodiazepines or opioids "as needed" for a vasectomy.

You have facial hair around your mouth that prevents a mask from fitting properly.

You have trouble thinking clearly and answering survey questions.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

1 week

1 visit (virtual or in-person)

Treatment

Participants undergo vasectomy with self-adjusted nitrous oxide for pain and anxiety management

1 day

1 visit (in-person)

Follow-up

Participants are monitored for safety and effectiveness after vasectomy, including surveys on pain, anxiety, and satisfaction

3 months

2 surveys (electronic)

What Are the Treatments Tested in This Trial?

Interventions

• Nitrous oxide

Trial Overview The study tests if self-administered nitrous oxide (laughing gas) during vasectomy reduces pain and anxiety compared to standard care. Participants will control their own intake of the gas to see if it improves their overall experience during the procedure.

How Is the Trial Designed?

Group I: Self-adjusted nitrous oxide (SANO) Experimental Treatment 1 Intervention

All patients will receive nitrous oxide at concentrations of minimal sedation (0-50%) throughout vasectomy.

Nitrous oxide is already approved in United States, European Union, Canada for the following indications:

Approved in United States as Nitrous Oxide for:

• Procedural sedation for mild to moderate pain
• Labor analgesia
• Dental anesthesia
• Emergency department analgesia

Approved in European Union as Nitrous Oxide for:

• Procedural sedation for mild to moderate pain
• Labor analgesia
• Dental anesthesia

Approved in Canada as Nitrous Oxide for:

• Procedural sedation for mild to moderate pain
• Labor analgesia
• Dental anesthesia

Who Is Running the Clinical Trial?

Beth Israel Deaconess Medical Center

Lead Sponsor

Trials

872

Recruited

12,930,000+

Published Research Related to This Trial

Inhalation of nitrous oxide and oxygen (N2O/O2) significantly reduces perioperative pain during first-trimester termination of pregnancy, as shown in a meta-analysis of four studies involving various pain assessments.

While N2O/O2 effectively alleviates pain during the procedure, it does not impact postoperative pain or secondary effects like nausea and vomiting, indicating its focused efficacy in managing pain during the procedure itself.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Nitrous oxide for pain management of first-trimester instrumental termination of pregnancy under local anaesthesia and/or minimal sedation: A systematic review and meta-analysis. Schmitt, A., Cardinale, C., Loundou, A., et al.[2022]

Nitrous oxide (N2O) is an effective analgesic and sedative used in dentistry, offering benefits like rapid onset and both pain relief and anxiety reduction.

Despite its advantages, nitrous oxide can lead to vitamin B12 deficiency and has potential risks such as infertility and neurological issues, highlighting the importance of using scavenger systems to reduce occupational exposure.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

[Not Available]. Liakoni, E., Liechti, ME.[2019]

In a study of 124 children aged 1-17 undergoing procedures in the emergency department, nitrous oxide (N2O) was used for analgesia, but pain scores showed that 34% of patients experienced significant pain (scores of 70 mm or greater) during procedures, indicating limited efficacy for very painful interventions.

Despite the pain management limitations, both parents (96% satisfaction) and staff (92% rated sedation and analgesia as adequate) reported high satisfaction with the use of N2O for procedural sedation in the emergency department.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Limited analgesic efficacy of nitrous oxide for painful procedures in children. Babl, FE., Oakley, E., Puspitadewi, A., et al.[2022]

Nitrous oxide is effective in reducing distress in children undergoing painful procedures, with 93% of patients achieving conscious sedation and 65% having no recollection of the procedure.

The treatment has minimal side effects, with 86% of patients experiencing none, and a quick recovery time of about three minutes, making it a safe option for managing pain in pediatric patients.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Efficacy and safety of nitrous oxide in alleviating pain and anxiety during painful procedures. Kanagasundaram, SA., Lane, LJ., Cavalletto, BP., et al.[2022]

In a study involving 34 children undergoing laceration repair, nitrous oxide (N2O) was found to significantly reduce pain behavior compared to a placebo, especially in children under 8 years old.

No side effects were reported, indicating that N2O is a safe and effective analgesic for outpatient procedures in children, with potential for even greater efficacy at higher concentrations (40-50% N2O) that still need further investigation.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Nitrous oxide analgesia in a pediatric emergency department. Gamis, AS., Knapp, JF., Glenski, JA.[2019]

A study involving 1,058 children aged 1-23 years demonstrated that nitrous oxide is a safe and effective sedation option for minor surgical procedures, with no major complications reported.

The use of nitrous oxide resulted in high patient satisfaction, with 98% of children denying pain from injections and 82% reporting mild or no procedural pain, highlighting its efficacy in reducing anxiety and discomfort during surgery.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Nitrous oxide procedural sedation in non-fasting pediatric patients undergoing minor surgery: a 12-year experience with 1,058 patients. Pasarón, R., Burnweit, C., Zerpa, J., et al.[2018]

Nitrous oxide (N2O) has been found to be effective in reducing pain during puncture biopsy procedures, showing a significant analgesic effect compared to controls like placebo and other sedatives, based on a review of 12 randomized controlled trials involving 1070 patients.

In addition to pain relief, N2O also significantly reduced patient anxiety and improved overall satisfaction without increasing the risk of common side effects such as nausea, headache, or dizziness.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Efficacy of nitrous oxide in adults undergoing puncture biopsy: A systematic review and meta-analysis of randomized controlled trials. Wang, Z., Wang, F., Xing, Y., et al.[2023]

Nitrous oxide (N2O) has been effectively used for over 170 years in dental anesthesia due to its rapid onset, analgesic, anxiolytic, and amnestic properties, making it a popular choice for procedural sedation.

While N2O is generally safe for use, it can cause irreversible inactivation of vitamin B12, which is crucial for health, and in rare cases, this can lead to serious or fatal outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Complications caused by nitrous oxide in dental sedation. Chi, SI.[2020]

In a study with 48 subjects, the use of 33% nitrous oxide and 67% oxygen significantly reduced the intensity of pain from electrical tooth pulp stimulation, but did not decrease the unpleasantness of the sensations.

The study found that 100% oxygen had no analgesic effect, highlighting the specific pain-relieving properties of nitrous oxide in dental procedures.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Nitrous oxide analgesia: a psychophysical evaluation using verbal descriptor scaling. Heft, MW., Gracely, RH., Dubner, R.[2017]

Healthcare professionals exposed to high levels of nitrous oxide (N2O) in the past faced significant reproductive risks, including congenital anomalies and reduced fertility rates, but these risks have been reduced due to occupational safety measures.

Recreational users of N2O often exceed safe exposure limits by a large margin, putting themselves at risk for similar reproductive issues, highlighting the need for increased awareness about these dangers among users, especially those who are pregnant or planning to become pregnant.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Nitrous oxide-induced reproductive risks: Should recreational nitrous oxide users worry? van Amsterdam, J., van den Brink, W.[2022]

In a study of 762 pediatric patients aged 1 to 17 years, high-concentration nitrous oxide (70%) was found to be safe for procedural sedation, with only 8.4% experiencing mild adverse events, primarily vomiting.

The study indicated that there was no significant difference in the incidence of adverse events between nitrous oxide concentrations of 70% and 50%, and both concentrations provided effective sedation without serious complications.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

High-concentration nitrous oxide for procedural sedation in children: adverse events and depth of sedation. Babl, FE., Oakley, E., Seaman, C., et al.[2022]

Nitrous oxide (N2O) is a safe and effective anesthetic and analgesic gas that can be used in various medical situations due to its low incidence of adverse effects.

It can be administered by trained medical providers or even self-administered by patients, making it a versatile option in clinical practice.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Update on nitrous oxide and its use in anesthesia practice. Zafirova, Z., Sheehan, C., Hosseinian, L.[2019]

In a study of 173 vascular and interventional procedures over 2 years, nitrous oxide was found to be a safe and effective analgesic, providing adequate pain relief in 74% of patients without premedication and 61% of those with premedication.

Minor complications such as nausea and vomiting were reported in a small number of patients, but these were easily managed by adjusting the nitrous oxide concentration, highlighting its safety profile.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Nitrous oxide: effective analgesic for vascular and interventional procedures. Braun, SD., Miller, GA., Ford, KK., et al.[2013]

Citations

1. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC10054065/

Effectiveness of Nitrous Oxide versus Pethidine/Midazolam ... Conclusions: Nitrous oxide is as effective as pethidine/midazolam for pain relief in minor gynecological operative procedures but associated ...

2. clinicaltrials.gov clinicaltrials.gov/study/NCT06661005

Nitrous Oxide for Pain Management During In-Office ... The purpose of this study is to evaluate the pain control, patient satisfaction, and efficiency of nitrous oxide used for anesthesia during ...

3. urologygroup.com urologygroup.com/nervous-about-a-vasectomy-laughing-gas-is-now-an-option/

Nervous About a Vasectomy? “Laughing Gas” is Now an ... Nitrous oxide (N2O) – also known as laughing gas – is a colorless, sweet-smelling gas that produces a sense of relaxation and an insensibility to pain.

4. sciencedirect.com sciencedirect.com/science/article/abs/pii/S0090429520305690

Use of Nitrous Oxide in Office-based Urologic Procedures Studies showed significant improvements in peri-procedural pain and anxiety relative to alternative (or none) forms of analgesia. Adverse effects were rare and ...

5. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC10243628/

Efficacy of nitrous oxide in adults undergoing puncture biopsy The present review suggested that N 2 O might be effective for pain management in patients undergoing puncture biopsy.

6. pubchem.ncbi.nlm.nih.gov pubchem.ncbi.nlm.nih.gov/compound/Nitrous-Oxide

Nitrous Oxide | N2O | CID 948 - PubChem Nitrous oxide is a colorless, sweet-tasting gas. It is also known as laughing gas. Continued breathing of the vapors may impair the decision making process.

7. apsf.org apsf.org/article/safety-and-utility-of-nitrous-oxide-for-labor-analgesia/

Safety and Utility of Nitrous Oxide for Labor Analgesia One study found no decrease in pain scores with nitrous oxide compared to placebo in early labor,8 and use of nitrous oxide did not lead to a significant ...

8. my.clevelandclinic.org my.clevelandclinic.org/health/treatments/nitrous-oxide-laughing-gas

Nitrous Oxide (Laughing Gas): Uses, Side Effects & Safety Nitrous oxide (laughing gas) is a sedative healthcare providers use to keep you comfortable during procedures. It's a colorless, faintly sweet-smelling gas.

9. aapd.org aapd.org/media/Policies_Guidelines/P_NitrousOxideHazards.pdf

Policy on Minimizing Occupational Health Hazards ... Occupational expo- sure to nitrous oxide during procedural pain control in children: A comparison of different inhalation techniques and scavenging systems.