Comparative Effectiveness Review Number 67 Nitrous Oxide for the Management of Labor Pain Comparative Effectiveness Review Number 67 Nitrous Oxide for the Management of Labor Pain Prepared for: Agency for Healthcare Research and Quality U.S. Department of Health and Human Services 540 Gaither Road Rockville, MD 20850 www.ahrq.gov Contract No. 290-2007-10065-I Prepared by: Vanderbilt Evidence-based Practice Center Institute for Medicine and Public Health Nashville, TN Investigators: Frances E. Likis, Dr.P.H., N.P., C.N.M. Jeffrey C. Andrews, M.D. Michelle R. Collins, Ph.D., M.S.N., C.N.M., R.N.C. Rashonda M. Lewis, J.D., M.H.A. Jeffrey J. Seroogy, B.S. Sarah A. Starr, M.D. Rachel R. Walden, M.L.I.S. Melissa L. McPheeters, Ph.D., M.P.H. AHRQ Publication No. 12-EHC071-EF 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 doc ument 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 infor mation 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 cove rage policies. AHRQ or U.S. Department of Health and Human Services endorsement of such derivative products may not be stated or implied. This document is in the public domain and may be used and reprinted without permission except those copyrighted materials that are clearly noted in the document. Further reproduction of those copyrighted materials is prohibited without the specific permission of copyright holders. Persons using assistive technology may not be able to fully access information in this report. For assistance contact [email protected]. None of the investigators have any affiliations or financial involvement that conflicts with the material presented in this report. Sugge sted 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. www.effectivehealthcare.ahrq.gov/reports/final.cfm. ii Preface The Agency for Healthcare Research and Quality (AHRQ) conducts the Effective Health Care Program as part of its mission to organize knowledge and make it available to inform decisions about health care. As part of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, Congress directed AHRQ to conduct and support research on the comparative outcomes, clinical effectiveness, and appropriateness of pharmaceuticals, devices, and health care services to meet the needs of Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP). AHRQ has an established network of Evidence-based Practice Centers (EPCs) that produce Evidence Reports/Technology Assessments to assist public- and private-sector organizations in their efforts to improve the quality of health care. The EPCs now lend their expertise to the Effective Health Care Program by conducting comparative effectiveness reviews (CERs) of medications, devices, and other relevant interventions, including strategies for how these items and services can best be organized, managed, and delivered. Systematic reviews are the building bloc ks underlying evidence-based practice; they focus attention on the strength and limits of evidence from research studies about the effectiveness and safety of a clinical intervention. In the context of developing recommendations for practice, systematic reviews are useful because they define the strengths and limits of the evidence, clarifying whether assertions about the value of the intervention are based on strong evidence from clinical studies. For more information about systematic reviews, see www.effectivehealthcare.ahrq.gov/reference/purpose.cfm. AHRQ expects that CERs will be helpful to health plans, providers, purchasers, government programs, and the health care system as a whole. In addition, AHRQ is committed to presenting information in different formats so that consumers who make decisions about their own and their family’s health can benefit from the evidence. Transparency and stakeholder input from are essential to the Effective Health Care Program. Please visit the Web site (www.effectivehealthcare.ahrq.gov) to see draft research questions and reports or to join an email list to learn about new program products and opportunities for input. Comparative Effectiveness Reviews will be updated regularly. We welcome comments on this CER. They may be sent by mail to the Task Order Officer named below at: Agency for Healthcare Research and Quality, 540 Gaither Road, Rockville, MD 20850, or by email to [email protected]. Carolyn M. Clancy, M.D. Stephanie Chang M.D., M.P.H. Director Director, EPC Program Agency for Healthcare Research and Quality Center for Outcomes and Evidence Agency for Healthcare Research and Quality Jean Slutsky, P.A., M.S.P.H. Director, Center for Outcomes and Evidence Shilpa H. Amin, M.D., M.Bsc, F.A.A.F.P. Agency for Healthcare Research and Quality Task Order Officer Center for Outcomes and Evidence Agency for Healthcare Research and Quality iii Acknowledgments We are indebted to a tireless and exceptional group of colleagues who made this report possible. Each step of a systematic review draws on the skills and attention of an entire team. Ms. Kerry Jordan served as project coordinator shepherding innumerable planning, implementation, and writing tasks to completion. She guided and contributed to production of the plethora of forms, spreadsheets, and tables that are required to produce reliable evidence tables and summary data. Her attentiveness to the needs of the investigator team and to pacing the work was especially valued. Ms. Tracy Shields is a key member of the library science staff and her detailed approach to abstract and full text review, evidence table construction, and quality scoring was invaluable. Ms. Kathy Lee was always willing to contribute time and effort when having extra assistance with tasks like printing and distributing articles and preparing meeting materials were a priority. We appreciate her generosity in helping while simultaneously assisting on several other major reports. Key Informants Judith Bishop, C.N.M., M.P.H. Ellice Lieberman, M.D., Dr.P.H. Professor, Obstetrics, Gynecology, and Professor, Department of Society, Human Reproductive Sciences Development, and Health, Department of University of California, San Francisco Epidemiology San Francisco, CA Brigham and Women's Hospital, Harvard Medical School William Camann, M.D. Boston, MA Director of Obstetric Anesthesia Brigham and Women's Hospital, Harvard Nancy K. Lowe, C.N.M., Ph.D., Medical School F.A.C.N.M., F.A.A.N. Boston, MA Chair for Division of Women, Children, and Family Health Sharon Holley, D.N.P., C.N.M. University of Colorado Denver College of Instructor of Nursing Nursing Vanderbilt University Nursing School Denver, CO Nashville, TN Judith Rooks, C.N.M., M.P.H., F.A.C.N.M. Holly Powell Kennedy, C.N.M., Ph.D., Courtesy Instructor, College of Public F.A.C.N.M., F.A.A.N. Health Helen Varney Professor of Midwifery University of South Florida Yale University School of Nursing Tampa, FL President, American College of Nurse- Midwives Carol Sakala, Ph.D., M.S.P.H. New Haven, CT Director of Programs Childbirth Connection New York, NY iv Technical Expert Panel Judith Bishop, C.N.M., M.P.H. Holly Powell Kennedy, C.N.M., Ph.D., Professor, Obstetrics, Gynecology, and F.A.C.N.M., F.A.A.N. Reproductive Sciences Helen Varney Professor of Midwifery University of California, San Francisco Yale University School of Nursing San Francisco, CA President, American College of Nurse- Midwives William Camann, M.D. New Haven, CT Director of Obstetric Anesthesia Brigham and Women's Hospital, Harvard Ellice Lieberman, M.D., Dr.P.H. Medical School Professor, Department of Society, Human Boston, MA Development, and Health, Department of Epidemiology Jo Davies, M.B.B.S., F.R.C.A. Brigham and Women's Hospital, Harvard Associate Professor, Anesthesiology and Medical School Pain Medicine Boston, MA University of Washington Seattle, WA Judith Rooks, C.N.M., M.P.H., F.A.C.N.M. Courtesy Instructor, College of Public Sharon Holley, D.N.P., C.N.M. Health Instructor of Nursing University of South Florida Vanderbilt University Nursing School Tampa, FL Nashville, TN Carol Sakala, Ph.D., M.S.P.H. Lucky Jain, M.D. Director of Programs Professor of Pediatrics, Executive Vice Childbirth Connection Chairman for Department of Pediatrics New York, NY Emory University School of Medicine Atlanta, GA v Peer Reviewers William Camann, M.D. Peter Norman, M.D., F.R.C.P.C. Director of Obstetric Anesthesia Professor, Anesthesiology & Perioperative Brigham and Women's Hospital, Harvard Medicine Medical School The University of Texas Boston, MA Houston, TX Jo Davies, M.B.B.S., F.R.C.A.