Lustgas som smärtlindring vid förlossning

Fråga till SBU:s upplysningstjänst

Finns det vetenskaplig evidens för att lustgas lindrar förlossnings­smärtor och vilka andra smärt­lindrings­metoder är likvärdiga eller bättre än lustgas?

Sammanfattning SBU:s upplysningstjänst

En systematisk översikt identifierades där olika former av inhalations­analgesi jämfördes sinsemellan, med transkutan elektrisk nerv­stimulering (TENS), placebo eller ingen behandling. Översikten fann att lustgas gav upphov till bättre smärtlindring än placebo eller ingen behandling. Däremot var den smärt­lindrande effekten sämre för lustgas än för fluranderivat. Lustgas gav även upphov till fler biverkningar i form av illamående, kräkningar och yrsel jämfört med fluranderivat. Den smärtlindrande effekten av TENS var likvärdig med den för lustgas.

Enligt författarna visade en randomiserad kontrollerad studie (RCT) att lustgas, jämfört med ingen behandling alls, gav viss smärtlindring. Likaledes ansåg författarna till två RCT-studier att kontinuerlig inhalering av lustgas gav en bättre smärt­lindrande effekt än växelvis (inter­mittent) inhalering. En RCT pekade mot att lustgas gav en bättre smärtlindrande effekt än petidin medan en annan RCT visade en snabbare smärtlindrande verkan för petidin, men att effekten var jämförbar med lustgas efter en timme. Två RCT-studier jämförde lustgas med antingen remifentanil eller remifentanil i kombination med lustgas. Författarna till dessa studier ansåg att remifentanil var att föredra som smärt­lindring, men gav upphov till en större sänkning i medvetandegrad.

Två observations­studier pekade enligt författarna på att en högre dos lustgas gav en bättre smärtlindrande effekt jämfört med en lägre dos lustgas. Tre observations­studier stödjer att rygg­bedövning ger bättre smärt­lindring än lustgas.

SBU har inte tagit ställning i sakfrågan eftersom de enskilda studiernas kvalitet inte bedömts och resultaten inte vägts samman. Här redovisas därför endast de enskilda studiernas slutsatser.

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