Entonox® inhalation to reduce pain in common diagnostic and therapeutic outpatient urological procedures: a review of the evidence

INTRODUCTION

Entonox^® (50% nitrous oxide and 50% oxygen; BOC Healthcare, Manchester, UK) is an analgesic and anxiolytic agent that is used to successfully reduce pain and anxiety during dental, paediatric and emergency department procedures. In this article we review the application and efficacy of Entonox^® in painful local anaesthesia urological procedures by performing a systematic review of the literature.

METHODS

A MEDLINE^® search was performed using the terms ‘nitrous oxide’, ‘Entonox’, ‘prostate biopsy’, ‘flexible cystoscopy’ and ‘extracorporeal shock wave lithotripsy’. English language publications of randomised studies were identified and reviewed.

RESULTS

The search yielded five randomised studies that investigated the clinical efficacy of Entonox^® as an analgesic for day case urological procedures. Three randomised controlled trials (RCTs) investigated Entonox^® in transrectal ultrasonography guided prostate biopsy. All three reported significant reductions in pain score in the Entonox^® versus control groups. One RCT reported significant reduction in pain during male flexible cystoscopy in the Entonox^® group compared with the control group. One RCT, which examined the use of Entonox^® during extracorporeal shock wave lithotripsy, found its use significantly decreased the pain score compared with the control group and this was comparable to intravenous pethidine.

CONCLUSIONS

Evidence from varied adult and paediatric procedures has shown Entonox^® to be an effective, safe and patient acceptable form of analgesia. All published studies of its use in urological day case procedures have found it to significantly reduce procedural pain. There is huge potential to use this cheap, safe, effective analgesic in our current practice.     

Effect of socio-demographic conditions on growth of urban school children of Bangladesh

The relationship between socio-demographic variables and growth of 242 school children from five schools in Dhaka city, Bangladesh, was investigated. The socio-demographic data were collected by questionnaire and the anthropometric data were collected by visits to each school on a prefixed date. Children from the high-family-income group showed significantly higher body weight, height, MUAC, SFT, wt/age, and ht/age compared with children from the low-family-income group. When the effect of age, sex, father's occupation and family size were adjusted for by means of multiple analysis of variance, the family income still showed a significant contribution to the variation in the anthropometric indices of these children. These findings suggest that family income makes a significant contribution as a determinant of growth of urban school children in Bangladesh.     

Mediastinal lymphangioma

Mediastinal lymphangioma is an uncommon benign tumor accounting for 0.7 to 4.5% of all mediastinal masses. Lymphangiomas consist of dilated cystic lymph spaces lined by single layers of endothelium and do not undergo malignant change. Most mediastinal lymphangiomas are asymptomatic. There are no specific radiological findings. Surgical excision is the treatment of choice and the prognosis is excellent.     

Uterus didelphys with fibroid uterus and ovarian cyst--rare Muellerian malformation

Persistent Muellerian duct syndrome is a very rare anomaly. A woman of 46-year-old was admitted with the history of lower abdominal pain, bleeding per vaginum and irregular menstrual cycles for last 6 months. An irregular non-tender mass of 16 x 10cm in size was palpable in suprapubic region. Per vaginal examination revealed two cervices and an incomplete vaginal septum. Ultrasound abdomen showed one uterus with endometrial cavity clearly delineated with a fibroid and an ovarian cyst in the left lumbar region. On laparotomy, 2 uterii along with a fibroid from the anterior wall of left uterus and a left ovarian cyst was seen. Patient had undergone total abdominal hysterectomy and adnexa removal. The specimen showed florid adenomyosis with leiomyoma of fibroid.     

Massive ascites due to pancreatitis

Summary Four cases of pancreatitis with pseudocysts and massive ascites are reported. The presence of massive ascites created great diagnostic difficulties which were solved only by measurement of the ascitic fluid amylase concentration and by peritoneoscopy.The possibility of pancreatitis as a cause of massive ascites should be kept in mind, particularly in chronic alcoholics. In the differential diagnosis, abdominal paracentesis and peritoneoscopy are very helpful.     

Intravascular angiomatosis in female urethral mass Masson intravascular hemangioendothelioma

A case of Masson intravascular hemangioendothelioma hitherto underscribed in the female urethra is reported. The condition has bizarre histopathologic appearances which sometimes pose a problem in differentiating it from angiosarcoma. Recognition of the condition, particularly in a female urethra which is not an infrequent site of vascular lesions such as caruncles and varices, is therefore emphasized to avoid unnecessary drastic treatment.