Great strides have been made in the prehospital and Emergency Department management of patients, yet the relief of pain and suffering is something that is often forgotten or, if not overlooked, provided in a suboptimal fashion. It is too easy not to feel the pain the patient has or that is is produced while one is seeking to help. The optimal analgesic should have rapid onset, short duration, few side effects, and no major adverse reactions. Nitrous oxide, known since 1776, is perhaps the drug that comes closest to meeting that ideal.