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Pain Research and Treatment
Volume 2017 (2017), Article ID 1793241, 7 pages
Clinical Study

Pain and Stress Response during Intravenous Access in Children with Congenital Adrenal Hyperplasia: Effects of EMLA and Nitrous Oxide Treatment

1Division of Paediatrics, Department for Clinical Science Intervention and Technology, Karolinska Institute, Karolinska University Hospital, 141 86 Stockholm, Sweden
2Division of Endocrinology, Diabetes and Metabolism, National Childhood Obesity Centre, Karolinska University Hospital, 141 86 Stockholm, Sweden

Correspondence should be addressed to K. Ekbom

Received 23 September 2017; Accepted 30 November 2017; Published 31 December 2017

Academic Editor: Donald A. Simone

Copyright © 2017 K. Ekbom. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Background. Congenital adrenal hyperplasia (CAH) is an endocrine condition that requires regularly blood samples for optimal treatment. The management of CAH in children is complex when intravenous access is one of the most stressful procedures for children. The purpose of this pilot study was to investigate the effects of nitrous oxide inhalation (N2O) in combination with cutaneous application of local anesthetics (EMLA) for improving intravenous access in children with CAH. Method. Ten children (7–14 years) were studied. The children received two intravenous procedures: one with EMLA and one with EMLA + N2O. The order of priority was randomized. The outcomes were the children’s pain experience (0–10) and an evaluation of satisfaction (1–5) after the procedure. Heart rate, blood pressure, saturation, and analyses of 17-hydroxyprogesterone (17-OHP), norepinephrine, and glucose were analyzed. Results. Higher pain scores, heart rate, and glucose levels were reported after EMLA, compared to EMLA + N2O, but 17-OHP levels remained unchanged. The children’s satisfaction with the intravenous procedure was more positive for EMLA + N2O. Conclusions. EMLA + N2O offers the possibility of improving the intravenous procedure for anxious children with CAH. Although the quality of care was better with N2O treatment, it was not possible to demonstrate that this is a prerequisite for valid 17-OHP measurements.