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Williams J, Wilson K. Inhaled methoxyflurane - an explorable alternative to nitrous oxide? Br Dent J 2024; 236:680-682. [PMID: 38730155 DOI: 10.1038/s41415-024-7336-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 12/04/2023] [Accepted: 12/13/2023] [Indexed: 05/12/2024]
Abstract
Nitrous oxide is a widely used and well-established form of inhalation sedation in dentistry. Its properties have a wide margin of safety and allow for anxious, paediatric and adult patients to receive dental treatment with minimal impact upon discharge. Nitrous oxide has drawbacks, however, including its environmental impact and need for specialist equipment. Methoxyflurane is another drug which could prove to be an alternative to nitrous oxide. Methoxyflurane's use has proved popular within emergency medicine in Australia and New Zealand for its potent analgesic effects and recognition of its anxiolytic effect. As a result, its use in invasive outpatient procedures has now become popular. Unfortunately, there is very limited evidence of its use within dentistry as a form of inhalation sedation and analgesic. A wider evidence base should be established, as methoxyflurane could prove to be an effective and environmentally friendly alternative to nitrous oxide.
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Affiliation(s)
- Jack Williams
- Clinical Teaching Fellow in Oral Surgery and Restorative Dentistry, Newcastle School of Dental Sciences, UK.
| | - Katherine Wilson
- Associate Specialist in Dental Sedation, Sedation Department, Newcastle Dental Hospital, United Kingdom
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2
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Martindale AE, Morris DS, Cromarty T, Fennell-Wells A, Duane B. Environmental impact of low-dose methoxyflurane versus nitrous oxide for analgesia: how green is the 'green whistle'? Emerg Med J 2024; 41:69-75. [PMID: 37770121 DOI: 10.1136/emermed-2022-213042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Accepted: 09/12/2023] [Indexed: 10/03/2023]
Abstract
BACKGROUND The NHS has the target of reducing its carbon emission by 80% by 2032. Part of its strategy is using pharmaceuticals with a less harmful impact on the environment. Nitrous oxide is currently used widely within the NHS. Nitrous oxide, if released into the atmosphere, has a significant environmental impact. Methoxyflurane, delivered through the Penthrox 'green whistle' device, is a short-acting analgesic and is thought to have a smaller environmental impact compared with nitrous oxide. METHODS Life cycle impact assessment (LCIA) of all products and processes involved in the manufacture and use of Penthrox, using data from the manufacturer, online sources and LCIA inventory Ecoinvent. These data were analysed in OpenLCA. Impact data were compared with existing data on nitrous oxide and morphine sulfate. RESULTS This LCIA found that Penthrox has a climate change effect of 0.84 kg carbon dioxide equivalent (CO2e). Raw materials and the production process contributed to majority of the impact of Penthrox across all categories with raw materials accounting for 34.40% of the total climate change impact. Penthrox has a climate change impact of 117.7 times less CO2e compared with Entonox. 7 mg of 100 mg/100 mL of intravenous morphine sulfate had a climate change effect of 0.01 kg CO2e. CONCLUSIONS This LCIA has shown that the overall 'cradle-to-grave' environmental impact of Penthrox device is better than nitrous oxide when looking specifically at climate change impact. The climate change impact for an equivalent dose of intravenous morphine was even lower. Switching to the use of inhaled methoxyflurane instead of using nitrous oxide in certain clinical situations could help the NHS to reach its carbon emission reduction target.
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Affiliation(s)
| | - Daniel S Morris
- Ophthalmology, University Hospital of Wales, Cardiff, UK
- Wilderness Medical Training, Wilderness Medical Training, Kendal, UK
| | - Thomas Cromarty
- Emergency Medicine, Southampton Children's Hospital, Southampton, UK
| | | | - Brett Duane
- Dental Science, Trinity College Dublin, Dublin, Ireland
- Dental Science, Trinity College Dublin, Dublin, Ireland
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3
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Tohira H, Brink D, Davids L, Brits R, Ball S, Schug S, Bailey P, Finn J. Use of ketamine wafer for pain management by volunteer emergency medical technicians in rural Western Australia. Emerg Med Australas 2023; 35:786-791. [PMID: 37127293 DOI: 10.1111/1742-6723.14226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 02/02/2023] [Accepted: 04/10/2023] [Indexed: 05/03/2023]
Abstract
OBJECTIVE To describe the use of sublingual ketamine wafers administered by volunteer emergency medical technicians (EMTs) for pain management to patients in rural Western Australia (WA). METHODS This retrospective cohort study included patients older than 12 years who were attended by volunteer EMTs in Esperance, Lancelin and Kalbarri, WA and received analgesic medications from 2018 to 2021. Patients who received ketamine wafers with/without other analgesics were compared to (i) patients who received only oral paracetamol and (ii) patients who received inhalational methoxyflurane without ketamine wafers with/without paracetamol. RESULTS The present study included 826 patients, among whom 149 patients received ketamine wafer with/without other analgesics, 82 paracetamol only and 595 methoxyflurane with/without paracetamol. Patients who received ketamine wafers were younger (median age 49 years vs 54 years for the paracetamol group vs 58 years for the methoxyflurane group), required a longer median transport interval (56 min vs 20 min vs 8 min), trauma-related (73% vs 35% vs 54%), and presented higher median initial pain score (9 vs 3 vs 8 out of 10) than those who received paracetamol and those who received methoxyflurane, respectively. Eight in the ketamine wafers group (5.4%) had a record of nausea/vomiting after the administration of ketamine wafers. CONCLUSIONS Sublingual ketamine wafer was administered by volunteer EMTs without any evidence of major adverse events in rural WA and deemed useful as an additional pain management option when long transport to hospital was needed. No other symptoms that may be associated with the use of ketamine were recorded.
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Affiliation(s)
- Hideo Tohira
- Prehospital, Resuscitation and Emergency Care Research Unit, Curtin School of Nursing, Curtin University, Perth, Western Australia, Australia
- Discipline of Emergency Medicine, Medical School, The University of Western Australia, Perth, Western Australia, Australia
| | - Deon Brink
- Prehospital, Resuscitation and Emergency Care Research Unit, Curtin School of Nursing, Curtin University, Perth, Western Australia, Australia
- St John Ambulance Western Australia, Perth, Western Australia, Australia
| | - Lauren Davids
- St John Ambulance Western Australia, Perth, Western Australia, Australia
| | - Rudolph Brits
- St John Ambulance Western Australia, Perth, Western Australia, Australia
| | - Stephen Ball
- Prehospital, Resuscitation and Emergency Care Research Unit, Curtin School of Nursing, Curtin University, Perth, Western Australia, Australia
- St John Ambulance Western Australia, Perth, Western Australia, Australia
| | - Stephan Schug
- Discipline of Anaesthesiology and Pain Medicine, Medical School, The University of Western Australia, Perth, Western Australia, Australia
| | - Paul Bailey
- St John Ambulance Western Australia, Perth, Western Australia, Australia
| | - Judith Finn
- Prehospital, Resuscitation and Emergency Care Research Unit, Curtin School of Nursing, Curtin University, Perth, Western Australia, Australia
- St John Ambulance Western Australia, Perth, Western Australia, Australia
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4
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Finkelstein S, Oliogu E, Yee A, Milton L, Rivlin L, Henry P, Behroozian T, Chow E, Finkelstein J. Literature review on the use of methoxyflurane in the management of pain in cancer-related procedures. Support Care Cancer 2023; 31:232. [PMID: 36961562 DOI: 10.1007/s00520-023-07694-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 03/16/2023] [Indexed: 03/25/2023]
Abstract
INTRODUCTION Self-administered methoxyflurane, also known as Penthrox, at a sub-anesthetic dose is a short-term, fast-acting, and safe analgesic that may provide suitable pain relief for cancer patients. This review aims to compile the existing evidence on methoxyflurane and its efficacy in reducing pain during cancer-related procedures. METHODS A literature search was conducted through OVID Medline and Embase. The search was limited to articles published between 2012 and 2021 and studies were included if they assessed the efficacy of methoxyflurane to reduce pain in cancer-related procedures. All types of cancer were included. RESULTS The literature search yielded seven studies published between 2012 and 2021. The studies analyzed assessed methoxyflurane use in prostate biopsy, colonoscopy, removal of brachytherapy rods, and bone marrow biopsy. Various research designs were employed, including three randomized controlled trials, two prospective observational studies, one retrospective, and one non-randomized controlled trial. In all, methoxyflurane has a demonstrated ability to reduce pain in these procedures. CONCLUSION In the limited studies available in evaluating the efficacy of methoxyflurane for reducing procedural pain during cancer-related procedures, all have demonstrated clinical equivalency or superiority. Pain relief appears to be equivalent however methoxyflurane overcomes the standard limitations of respiratory sedation and has demonstrated quicker procedural recovery times than traditional sedation methods. The accumulated data to date supports the use of methoxyflurane which can supplement or supplant current methods of analgesia in cancer-related procedures.
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Affiliation(s)
- Samuel Finkelstein
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Etinosa Oliogu
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Albert Yee
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
- Division of Orthopaedic Surgery, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
| | - Lauren Milton
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | | | - Patrick Henry
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
- Division of Orthopaedic Surgery, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
| | - Tara Behroozian
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Edward Chow
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Joel Finkelstein
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada.
- Division of Orthopaedic Surgery, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada.
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Wood C. Trauma pain management in the emergency department: use of methoxyflurane as a patient-administered analgesic. Emerg Nurse 2022; 30:25-30. [PMID: 35709005 DOI: 10.7748/en.2022.e2124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2021] [Indexed: 06/15/2023]
Abstract
Evidence suggests that pain is highly prevalent among patients with traumatic injuries who attend emergency departments (EDs), yet accurate assessment and management of patients with acute pain can be challenging in this setting. Effective and rapid pain management is beneficial for patients and can support timely discharge from the ED, which is particularly important in the context of the coronavirus disease 2019 (COVID-19) pandemic. This article describes a service development project that introduced the use of a patient-administered analgesic, methoxyflurane, for patients with traumatic injuries with moderate to severe pain in one ED. The author outlines the benefits and rationale for using methoxyflurane as a first-line analgesic in this patient group and describes the main elements of training sessions for emergency nurses and other ED clinicians in the administration and supervision of patient-administered methoxyflurane.
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Affiliation(s)
- Craig Wood
- Epsom Hospital, Epsom and St Helier University Hospitals NHS Trust, Surrey, England
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Smith MD, Rowan E, Spaight R, Siriwardena AN. Evaluation of the effectiveness and costs of inhaled methoxyflurane versus usual analgesia for prehospital injury and trauma: non-randomised clinical study. BMC Emerg Med 2022; 22:122. [PMID: 35799131 PMCID: PMC9261021 DOI: 10.1186/s12873-022-00664-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 06/01/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND We aimed to investigate clinical benefits and economic costs of inhaled methoxyflurane when used by ambulance staff for prehospital emergency patients with trauma. Comparison is to usual analgesic practice (UAP) in the UK in which patient records were selected if treatment had been with Entonox® or intravenous morphine or intravenous paracetamol. METHODS Over a 12-month evaluation period, verbal numerical pain scores (VNPS) were gathered from adults with moderate to severe trauma pain attended by ambulance staff trained in administering and supplied with methoxyflurane. Control VNPS were obtained from ambulance database records of UAP in similar patients for the same period. Statistical modelling enabled comparisons of methoxyflurane to UAP, where we employed an Ordered Probit panel regression model for pain, linked by observational rules to VNPS. RESULTS Overall, 96 trained paramedics and technicians from the East Midlands Ambulance Service NHS Trust (EMAS) prepared 510 doses of methoxyflurane for administration to a total of 483 patients. Comparison data extracted from the EMAS database of UAP episodes involved: 753 patients using Entonox®, 802 patients using intravenous morphine, and 278 patients using intravenous paracetamol. Modelling results included demonstration of faster pain relief with inhaled methoxyflurane (all p-values < 0.001). Methoxyflurane's time to achieve maximum pain relief was estimated to be significantly shorter: 26.4 min (95%CI 25.0-27.8) versus Entonox® 44.4 min (95%CI 39.5-49.3); 26.5 min (95%CI 25.0-27.9) versus intravenous morphine 41.8 min (95%CI 38.9-44.7); 26.5 min (95%CI 25.1-28.0) versus intravenous paracetamol 40.8 (95%CI 34.7-46.9). Scenario analyses showed that durations spent in severe pain were significantly less for methoxyflurane. Costing scenarios showed the added benefits of methoxyflurane were achieved at higher cost, eg versus Entonox® the additional cost per treated patient was estimated to be £12.30. CONCLUSION When administered to adults with moderate or severe pain due to trauma inhaled methoxyflurane reduced pain more rapidly and to a greater extent than Entonox® and parenteral analgesics. Inclusion of inhaled methoxyflurane to the suite of prehospital analgesics provides a clinically useful addition, but one that is costlier per treated patient.
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Affiliation(s)
- Murray D Smith
- Community and Health Research Unit, University of Lincoln, Lincoln, UK.
| | - Elise Rowan
- Community and Health Research Unit, University of Lincoln, Lincoln, UK
| | - Robert Spaight
- Clinical Audit and Research Unit, East Midlands Ambulance Service NHS Trust, Nottingham, UK
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Lojo Rial C, Ozainne F, Fehlmann C, Von Düring S, Cottet P. [Acute pain management : the role of inhaled methoxyflurane in clinical practice]. Rev Med Suisse 2020; 16:553-556. [PMID: 32186802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Since 2018, a new analgesic drug has been made available in Switzerland : methoxyflurane. This halogenated gas, controlled by the patient, offers a very effective analgesic effect comparable to opiates. Known since the 1960s and used mainly in pre-hospital emergency medicine in Australia and New Zealand, its use in Europe is increasing alongside standard analgesic treatments in the traumatic setting. Administered by inhalation, it does not require an intravenous access, which is ideal in prehospital emergency situations. This treatment could be used for the management of acute pain of various origins, such as renal lithiasis, or to facilitate different procedures, such as closed fracture reduction or chest tube insertion. Its indications are growing and its use will probably become commonplace with clinicians in a near future.
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Affiliation(s)
| | - Florian Ozainne
- Service d'ambulance A.C.E. Ambulances, Route de Jussy 2, 1225 Chêne-Bourg
- École supérieure de soins ambulanciers, Chemin des Bougeries 15, 1231 Conches
| | | | - Stephan Von Düring
- Service d'ambulance A.C.E. Ambulances, Route de Jussy 2, 1225 Chêne-Bourg
- Service des soins intensifs, Département de médecine aiguë, HUG, 1211 Genève 14
| | - Philippe Cottet
- Service d'ambulance A.C.E. Ambulances, Route de Jussy 2, 1225 Chêne-Bourg
- Service des urgences, Département de médecine aiguë, HUG, 1211 Genève 14
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Viglino D, Termoz Masson N, Verdetti A, Champel F, Falcon C, Mouthon A, Mabiala Makele P, Collomb Muret R, Maindet Dominici C, Maignan M. Multimodal oral analgesia for non-severe trauma patients: evaluation of a triage-nurse directed protocol combining methoxyflurane, paracetamol and oxycodone. Intern Emerg Med 2019; 14:1139-1145. [PMID: 31290084 DOI: 10.1007/s11739-019-02147-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 07/03/2019] [Indexed: 01/03/2023]
Abstract
Insufficient analgesia affects around 50% of emergency department patients. The use of a protocol helps to reduce the risk of oligoanalgesia in this context. Our objective was to describe the feasibility and efficacy of a multimodal analgesia protocol (combining paracetamol, oxycodone, and inhaled methoxyflurane) initiated by triage nurse. We performed a prospective, observational study in an emergency department (Grenoble Alpes University Hospital, France) between December 2017 and April 2018. Adult non-severe trauma patients with a numerical pain rating scale (NRS) score ≥ 4 were included. The primary efficacy criterion was the proportion of patients with an NRS score ≤ 3 at 15 min. Pain intensity was measured for 60 min and during radiography. Data on adverse events and satisfaction were recorded. A total of 200 adult patients were included (median [interquartile range (IQR)] age: 32 [23-49] years; 126 men (63%)). Sixty-six patients (33%) reported an NRS score ≤ 3 at 15 min. The time required to achieve a decrease of at least 2 points in the NRS score was 10 (5-20) min. The median [IQR] pain intensity was 4 [2-5] before radiography and 4 [2-6] during radiography. Adverse events were frequent (n = 128, 64%). No serious adverse events were reported. The patients and caregivers reported good levels of satisfaction. The administration of a nurse-driven multimodal analgesia protocol (combining paracetamol, oxycodone, and methoxyflurane) was feasible on admission to the emergency department. It rapidly produced long-lasting analgesia in adult trauma patients.Trial registration: NCT03380247.
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Affiliation(s)
- Damien Viglino
- Emergency Department, Grenoble Alpes University Hospital, HP2 INSERM U1042, CS 10217, 38043, Grenoble Cedex 9, France
| | - Nicolas Termoz Masson
- Emergency Department, Grenoble Alpes University Hospital, HP2 INSERM U1042, CS 10217, 38043, Grenoble Cedex 9, France
| | - Agnès Verdetti
- Emergency Department, Grenoble Alpes University Hospital, HP2 INSERM U1042, CS 10217, 38043, Grenoble Cedex 9, France
| | - Flore Champel
- Emergency Department, Grenoble Alpes University Hospital, HP2 INSERM U1042, CS 10217, 38043, Grenoble Cedex 9, France
| | - Cédric Falcon
- Emergency Department, Grenoble Alpes University Hospital, HP2 INSERM U1042, CS 10217, 38043, Grenoble Cedex 9, France
| | - Alexis Mouthon
- Emergency Department, Grenoble Alpes University Hospital, HP2 INSERM U1042, CS 10217, 38043, Grenoble Cedex 9, France
| | - Prudence Mabiala Makele
- Emergency Department, Grenoble Alpes University Hospital, HP2 INSERM U1042, CS 10217, 38043, Grenoble Cedex 9, France
| | - Roselyne Collomb Muret
- Emergency Department, Grenoble Alpes University Hospital, HP2 INSERM U1042, CS 10217, 38043, Grenoble Cedex 9, France
| | | | - Maxime Maignan
- Emergency Department, Grenoble Alpes University Hospital, HP2 INSERM U1042, CS 10217, 38043, Grenoble Cedex 9, France.
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Fabbri A, Carpinteri G, Ruggiano G, Bonafede E, Sblendido A, Farina A, Soldi A. Methoxyflurane Versus Standard of Care for Acute Trauma-Related Pain in the Emergency Setting: Protocol for a Randomised, Controlled Study in Italy (MEDITA). Adv Ther 2019; 36:244-256. [PMID: 30467809 PMCID: PMC6318254 DOI: 10.1007/s12325-018-0830-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Indexed: 01/03/2023]
Abstract
Introduction Low-dose methoxyflurane, administered via a hand-held inhaler, has been used for short-term pain relief in emergency medicine in Australia and New Zealand for over 40 years, and was recently approved in Europe for the rapid relief of moderate-to-severe trauma-related pain in adults. There is currently a lack of data for methoxyflurane versus active comparators, therefore this trial will investigate the efficacy and safety of inhaled methoxyflurane compared with standard of care (SoC) in the treatment of acute trauma-related pain in pre-hospital and ED settings in Italy. Methods MEDITA (Methoxyflurane in Emergency Department in ITAly) is a Phase IIIb, prospective, randomised, active-controlled, parallel-group, open-label, multicentre trial. A total of 272 adult patients with moderate-to-severe pain [score ≥ 4 on the Numerical Rating Scale (NRS)] due to limb trauma will be randomised 1:1 to receive 3 mL methoxyflurane (self-administered by the patient via inhalation under supervision of a trained person) or medications that currently comprise the SoC in Italy [intravenous (IV) morphine for severe pain (NRS ≥ 7); IV paracetamol or ketoprofen for moderate pain (NRS 4–6)], administered as soon as possible after randomisation. Planned Outcomes Pain intensity will be measured using a 100-mm visual analogue scale (VAS) at baseline (time of randomisation) and at intervals up to 30 min. Time of onset of pain relief as reported by the patient and use of rescue medication will be recorded. The patient will rate the efficacy and the healthcare professional will rate the practicality of study treatment at 30 min after randomisation using a 5-point Likert scale. Adverse events will be recorded until safety follow-up at 14 ± 2 days. Vital signs will be measured at baseline, 10 and 30 min. The primary aim is to demonstrate non-inferiority of methoxyflurane versus SoC for the change in VAS pain intensity from baseline (randomisation) to 3, 5 and 10 min. Trial Registration EudraCT number: 2017-001565-25. Clinicaltrials.gov identifier: NCT03585374. Funding Mundipharma Pharmaceuticals srl. Electronic supplementary material The online version of this article (10.1007/s12325-018-0830-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Andrea Fabbri
- Department of Emergency Medicine, Morgagni-Pierantoni Hospital, Forlì, Italy
| | - Giuseppe Carpinteri
- Department of Emergency Medicine, Vittorio Emanuele University Hospital, Catania, Italy
| | - Germana Ruggiano
- Emergency Medicine Department, Santa Maria Annunziata Hospital, Florence, Italy
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10
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Boĭko VV, Sushkov SV, Zamiatin PN, Krut'ko EN. [Application of penthrox preparation in patients with traumatic disease]. Klin Khir 2011:36-37. [PMID: 21846031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Indications for preparation Pentrox application in injured persons, suffering traumatic disease, were substantiated. The pain syndrome dynamics while conducting analgesia, was investigated, using simple verbal scale.
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11
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Windsor J, van der Kaaij J, Ellerton J, Oxer H, Hillebrandt D, Rodway G. Methoxyflurane as an analgesic for prehospital use at high altitude. High Alt Med Biol 2009; 10:201-2. [PMID: 19519222 DOI: 10.1089/ham.2008.1075] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Abstract
Anecdotal reports of mechanical failure of morphine autojets have triggered a review of possible alternatives. Methoxyflurane is one such alternative already widely used by the Australian and New Zealand Defence Forces. The potential benefits and likely significant drawbacks of methoxyflurane are reviewed with the aim of stimulating discussion.
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Affiliation(s)
- J V McLennan
- Department of Emergency Medicine, Manchester Royal Infirmary, Manchester, M13 9WL.
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13
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Abstract
BACKGROUND Methoxyflurane (MF), a potent volatile anesthetic, can be used as an analgesic in subanesthetic concentrations. In Australia, MF is extensively used in children and adults as an analgesic in the prehospital setting via a hand-held inhaler device. We conducted a pilot study to explore its use as a patient controlled analgesic for painful procedures in children in the emergency department (ED). METHODS This is a prospective observational case series of children aged 5 years and older requiring procedural analgesia for brief painful procedures. Pain scores, depth of sedation, adverse events and patient, parent and staff satisfaction were assessed as well as consumption of MF measured. RESULTS Fourteen patients (aged 6-13 years) received MF mainly for extremity injuries. Amount of MF consumed ranged from 0.36 to 3.06 g per patient inhaled over 4-25 min. There were no serious adverse events. No patient was deeply sedated. Five patients had mild brief self-resolving adverse events including agitation, euphoria, blurry vision, dizziness and cough. Four patients with fractures with initial high pain scores (> or =6) received MF for bridging analgesia with large drops in pain scores. Four patients who required fracture reductions with initial low scores did not achieve adequate analgesia. The remaining six patients had painful procedures undertaken with satisfactory analgesia. CONCLUSIONS On the basis of this small pilot study of MF use in children in the ED, this agent appears to be a powerful analgesic. MF seems most useful as a self-titrated bridging analgesic agent in patients after extremity trauma. It appears less useful as a procedural agent when patients are unable to anticipate and achieve a sufficient level of analgesia before painful stimulus infliction. Pre- and intraprocedure coaching is an important aspect of its use especially if initial pain scores are low.
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MESH Headings
- Adolescent
- Analgesia, Patient-Controlled/adverse effects
- Analgesia, Patient-Controlled/instrumentation
- Analgesia, Patient-Controlled/methods
- Anesthesia, Inhalation/adverse effects
- Anesthesia, Inhalation/instrumentation
- Anesthesia, Inhalation/methods
- Anesthetics, Inhalation/administration & dosage
- Anesthetics, Inhalation/adverse effects
- Anesthetics, Inhalation/therapeutic use
- Australia
- Child
- Dose-Response Relationship, Drug
- Humans
- Methoxyflurane/administration & dosage
- Methoxyflurane/adverse effects
- Methoxyflurane/therapeutic use
- Pain/drug therapy
- Pain Measurement/methods
- Pain Measurement/statistics & numerical data
- Patient Satisfaction/statistics & numerical data
- Pilot Projects
- Prospective Studies
- Time Factors
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Affiliation(s)
- Franz Babl
- Department of Emergency Medicine, Royal Children's Hospital and Murdoch Childrens Research Institute, Melbourne, Australia.
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Abstract
Energy dynamics in 10 burned children were studied to determine cause and effect relationships between rates of heat production, heat loss and plasma catecholamine concentrations when thermoregulatory responses were depressed by methoxyflurane anesthesia. Rapid cooling of the burned children was due to increased heat loss during the period of anesthesia. Heat production increased significantly, although not enough to counterbalance the increased heat loss reflecting a block in central thermoregulation by general anesthesia. Mean plasma catecholamine concentrations decreased during general anesthesia as compared with baseline values. Heat production attempted to track heat loss during a period in which plasma catecholamine levels declined. An increased rate of heat loss is concluded to be primary stimulus for increased metabolic acitvity after thermal injury.
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Lüscher KP, Käch O. [Anesthesia in vaginal breech presentation]. Gynakol Rundsch 1980; 20 Suppl 1:62-3. [PMID: 7194238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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Pogorelko AG. [Methoxyflurane analgesia]. Voen Med Zh 1979:54. [PMID: 473651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Zhorov IS, Zhorov VI. [Pain control, analgesia]. Sov Med 1974:49-52. [PMID: 4610799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Josephson CA, Schwartz W. The Cardiff inhaler and penthrane. A method of sedation-analgesia in routine dentistry. J Dent Assoc S Afr 1974; 29:77-80. [PMID: 4534883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Moe N. [Obstetric analgesia and anesthesia with the Penthrane Analgizer]. Tidsskr Nor Laegeforen 1973; 93:2090-1. [PMID: 4544037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
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Endo M, Iizumi K, Isshiki J, Ito K, Muto Y. [Postoperative pain relief with the penthrane analgizer]. Masui 1973; 22:571-80. [PMID: 4737613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Brady JP. Research and training needs in behavior therapy. Semin Psychiatry 1972; 4:185-90. [PMID: 4155535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Yakaitis RW, Cooke JE, Redding JS. Self-administered methoxyflurane for postoperative pain: effectiveness and patient acceptance. Anesth Analg 1972; 51:208-12. [PMID: 4551090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Abstract
The requirements for analgesia for burns dressings are discussed. Methoxyflurane has proved satisfactory in a clinical trial, and can be administered by one of two types of vaporizer. The possibility of nephrotoxicity due to methoxyflurane has not been eliminated.
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Hawtof DB. Skin cleaning fluids for use with drum-type dermatomes. Plast Reconstr Surg 1971; 48:171. [PMID: 5561892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Loebel JP MARGO GM. The mechanism of therapy by desensitization. S Afr Med J 1971; 45:781-4. [PMID: 5095430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
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Oduro KA. Experiences with the "penthrane analgizer". Ghana Med J 1971; 10:43-7. [PMID: 5173735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
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Ackermann U, Beckmann W, Foitzik H, Lawin P. [Analgesia with methoxyflurane]. Z Prakt Anasth 1971; 6:49-55. [PMID: 4255680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Liljedahl SO, Norberg KA, Wåhlin A. [The use of a penthrane analgizer in the treatment of burns]. Lakartidningen 1970; 67:2153-7. [PMID: 5450554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Tanaka R, Watanabe T, Noguchi I, Mekari K. [Effect of methoxyflurane inhalation using the Analgizer on acids-base balance during pain relief]. Masui 1970; 19:379-86. [PMID: 5464951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Schulte-Steinberg O. [Induction of methoxyflurane (penthrane) anesthesia with propanidid (epontol)]. Anaesthesist 1969; 18:334-7. [PMID: 5397505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Clark RB, Cooper JO, Brown WE, Greifenstein FE. Experiences with chemical resuscitation of the newborn. Anesth Analg 1968; 47:285-9. [PMID: 4871152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Kristoffersen MB. [Anesthetic properties of methoxyflurane. A comparison with cyclopropane]. Nord Med 1967; 78:961-5. [PMID: 5339532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Cabrai M, Delfino U, Piazza L. [ Considerations on the use of methoxyflurane in pleuropulmonary surgery]. Minerva Anestesiol 1966; 32:361-8. [PMID: 5981920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Thuriès J, Pietri J. [Obstetrical analgesia-anesthesia by methoxyflurane]. Cah Anesthesiol 1965; 13:741-58. [PMID: 5853850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Merialdi A. [The penthrane-oxytocin-palerol combination in labor]. Quad Clin Ostet Ginecol 1965; 20:375-85. [PMID: 5867222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Di Giorgi F, Russo S. [The use of methoxyflurane in otorhinolaryngeal surgery]. Clin Otorinolaringoiatr 1965; 17:241-54. [PMID: 5881743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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