{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,28]],"date-time":"2026-05-28T16:31:43Z","timestamp":1779985903856,"version":"3.53.1"},"reference-count":29,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2016,9,25]],"date-time":"2016-09-25T00:00:00Z","timestamp":1474761600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Euro J of Neurology"],"published-print":{"date-parts":[[2017,1]]},"abstract":"<jats:sec><jats:title>Background and purpose<\/jats:title><jats:p>Lumbar puncture (<jats:styled-content style=\"fixed-case\">LP<\/jats:styled-content>) has been frequently performed for more than a century. This procedure is still stressful and often painful. The aim of the study was to evaluate the efficacy of a fixed 50% nitrous oxide\u2212oxygen mixture compared to placebo to reduce immediate procedural pain and anxiety during <jats:styled-content style=\"fixed-case\">LP<\/jats:styled-content>.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A randomized controlled trial was conducted involving adults who needed a cerebrospinal fluid analysis. Patients were randomly assigned to inhale either a fixed 50% nitrous oxide\u2212oxygen mixture (50% N<jats:sub>2<\/jats:sub>O\u2212O<jats:sub>2<\/jats:sub>) or medical air (22% O<jats:sub>2<\/jats:sub>\u221278% N<jats:sub>2<\/jats:sub>). Cutaneous application of a eutectic mixture of local anaesthetics was systematically done and all <jats:styled-content style=\"fixed-case\">LP<\/jats:styled-content>s were performed with pencil point 25G needles (20G introducer needle). The primary end\u2010point was the maximal pain level felt by the patient during the procedure, the maximal anxiety level being a secondary outcome, both measured using a numerical rating scale (0\u201310).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 66 consecutive patients were randomized. The analysis was intention to treat. The maximal pain was 4.9 \u00b1 2.7 for the 33 patients receiving air and 2.7 \u00b1 2.7 for the 33 receiving 50% N<jats:sub>2<\/jats:sub>O\u2212O<jats:sub>2<\/jats:sub> (<jats:italic>P<\/jats:italic> = 0.002). Similarly, the maximal <jats:styled-content style=\"fixed-case\">LP<\/jats:styled-content>\u2010induced anxiety was 4.5 \u00b1 3.1 vs. 2.6 \u00b1 2.6 (<jats:italic>P<\/jats:italic> = 0.009), respectively. The number needed to treat to avoid one patient undergoing significant pain (pain score \u2265 4\/10) was 2.75. Body mass index &gt;25 kg\/m<jats:sup>2<\/jats:sup> was significantly associated with higher pain intensity (<jats:italic>P<\/jats:italic> = 0.03). No serious adverse events were attributable to 50% N<jats:sub>2<\/jats:sub>O\u2212O<jats:sub>2<\/jats:sub> inhalation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Inhalation of a fixed 50% N<jats:sub>2<\/jats:sub>O\u2212O<jats:sub>2<\/jats:sub> mixture is efficient to reduce <jats:styled-content style=\"fixed-case\">LP<\/jats:styled-content>\u2010induced pain and anxiety.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ene.13127","type":"journal-article","created":{"date-parts":[[2016,9,26]],"date-time":"2016-09-26T03:52:46Z","timestamp":1474861966000},"page":"46-52","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Fixed 50:50 mixture of nitrous oxide and oxygen to reduce lumbar\u2010puncture\u2010induced pain: a randomized controlled trial"],"prefix":"10.1111","volume":"24","author":[{"given":"X.","family":"Moisset","sequence":"first","affiliation":[{"name":"Service de Neurologie CHU Clermont\u2010Ferrand Clermont\u2010Ferrand France"},{"name":"Clermont\u2010Ferrand and Inserm U1107 Clermont Universit\u00e9, Universit\u00e9 d'Auvergne, Neuro\u2010Dol Clermont\u2010Ferrand France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M. 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