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Background  Microsurgical tenets and peritoneal conditioning during laparoscopic surgery (LS) decrease postoperative adhesions and pain. For a trial in human, the strong beneficial effects of N 2 O needed to be confirmed in open surgery (OS).    Results  In a mouse model for OS, the effect of the gas environment upon adhesions was evaluated. Experiment I evaluated desiccation and the duration of exposure to CO 2 , N 2 O or CO 2  + 4%O 2 . Experiment II evaluated the dose-response curve of adding N 2 O to CO 2 . Experiment III compared humidified CO 2  + 10% N 2 O during LS and OS.  In OS, 30- and 60-min exposure to non-humidified CO 2  caused mortality of 33 and 100%, respectively. Mortality was prevented by humidification, by dry N 2 O or dry CO 2  + 4%O 2 . Adhesions increased with the duration of exposure to CO 2  ( p  < 0.0001) and decreased slightly by humidification or by the addition of 4% O 2 . N 2 O strongly decreased adhesions at concentrations of 5% or greater. With humidified CO 2  + 10% N 2 O, adhesion formation was similar in OS and LS.    Conclusions  The drug-like and strong beneficial effect of low concentrations of N 2 O is confirmed in OS.

N2O strongly prevents adhesion formation and postoperative pain in open surgery through a drug-like effect