Cover of Nitrous Oxide for the Management of Labor Pain

Nitrous Oxide for the Management of Labor Pain

Comparative Effectiveness Reviews, No. 67

Investigators: , DrPH, NP, CNM, , MD, , PhD, MSN, CNM, RNC, , JD, MHA, , BS, , MD, , MLIS, and , PhD, MPH.

Vanderbilt Evidence-based Practice Center
Rockville (MD): Agency for Healthcare Research and Quality (US); .
Report No.: 12-EHC071-EF

Structured Abstract


The Vanderbilt Evidence-based Practice Center systematically reviewed evidence addressing the use of nitrous oxide for the management of labor pain.

Data Sources:

We searched the MEDLINE®, Embase, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases for articles published in English.

Review Methods:

We excluded studies that did not address a Key Question, were not original research, or had fewer than 20 participants. We identified a total of 58 publications, representing 59 distinct study populations: 2 of good quality, 11 fair, and 46 poor.


Inhalation of nitrous oxide provided less effective pain relief than epidural analgesia, but the quality of studies was predominately poor. The heterogeneous outcomes used to assess women's satisfaction with their birth experience and labor pain management made synthesis of studies difficult. The strength of evidence was insufficient to determine the effect of nitrous oxide on route of birth. Most maternal harms reported in the literature were unpleasant side effects that affect tolerability (e.g., nausea, vomiting, dizziness, and drowsiness). Apgar scores in newborns whose mothers used nitrous oxide were similar to those of newborns whose mothers used other labor pain management methods or no analgesia. Evidence about occupational harms and exposure was limited.


The literature addressing nitrous oxide for the management of labor pain has few studies of good or fair quality. Synthesis of effectiveness and satisfaction studies is challenging because of heterogeneous interventions, comparators, and outcome measures. Research assessing nitrous oxide is needed across all of the Key Questions addressed: effectiveness, women's satisfaction, route of birth, harms, and health system factors affecting use.

Prepared for: Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services1, Contract No. 290-2007-10065-I. Prepared by: Vanderbilt Evidence-based Practice Center, Institute for Medicine and Public Health, Nashville, TN

Suggested citation:

Likis FE, Andrews JA, Collins MR, Lewis, RM, Seroogy JJ, Starr SA, Walden RR, McPheeters ML. Nitrous Oxide for the Management of Labor Pain. Comparative Effectiveness Review No. 67. (Prepared by the Vanderbilt Evidence-based Practice Center under Contract No. 290-2007-10065-I.) AHRQ Publication No. 12-EHC071-EF. Rockville, MD: Agency for Healthcare Research and Quality; August 2012.

This report is based on research conducted by the Vanderbilt Evidence-based Practice Center (EPC) under contract to the Agency for Healthcare Research and Quality (AHRQ), Rockville, MD (Contract No. 290-2007-10065-I). The findings and conclusions in this document are those of the authors, who are responsible for its contents; the findings and conclusions do not necessarily represent the views of AHRQ. Therefore, no statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services.

The information in this report is intended to help health care decisionmakers—patients and clinicians, health system leaders, and policymakers, among others—make well-informed decisions and thereby improve the quality of health care services. This report is not intended to be a substitute for the application of clinical judgment. Anyone who makes decisions concerning the provision of clinical care should consider this report in the same way as any medical reference and in conjunction with all other pertinent information, i.e., in the context of available resources and circumstances presented by individual patients.

This report may be used, in whole or in part, as the basis for development of clinical practice guidelines and other quality enhancement tools, or as a basis for reimbursement and coverage policies. AHRQ or U.S. Department of Health and Human Services endorsement of such derivative products may not be stated or implied.

None of the investigators have any affiliations or financial involvement that conflicts with the material presented in this report.


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Bookshelf ID: NBK100802PMID: 23016161