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Rydlöv HS, Fjose LO, Heyerdahl F. Pain Management with Inhalation of Methoxyflurane Administrated by Non-Medical Ski Patrol: A Quality Assessment Study. Pain Ther 2023; 12:1455-1463. [PMID: 37578680 PMCID: PMC10616009 DOI: 10.1007/s40122-023-00547-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 07/21/2023] [Indexed: 08/15/2023] Open
Abstract
INTRODUCTION Pain management can be challenging, especially in remote locations where first responders are not certified health care personnel. In these settings, traditional intravenous administration of analgesics is not feasible. In this study, we explore the feasibility of using methoxyflurane as a first-line analgesic in ski-related traumas, administered by the ski patrol, acting as the municipality physician's aiding personnel. METHODS This is a quality assessment of a project aimed at improving pain management in trauma patients at the largest ski resort in Norway. Members of the ski patrol were trained and delegated administration of methoxyflurane on behalf of the municipality physician. Patients > 18 years with ski-related trauma and pain Numeric Rating Scale (NRS) of 6 or more were included. The patients received inhalational methoxyflurane on site, with continued administration during transport. Data were collected by the ski patrol and entered into a quality register. RESULTS In total, 53 patients (18 to 76 years, 32 (60%) males) accepted to be registered. The injuries were fractures in 35 (66%), joint luxation in seven (13%), combination of fracture and luxation in seven (13%), and blunt soft tissue damage in four (8%) cases. Median NRS before administration of methoxyflurane was 8 decreasing to median NRS 5 after 5-10 min. The median NRS reduction of 3 (25-75% percentiles 2-5) was significant, p < 0.001. Patients rated the perceived effect as good in 40 (80%) moderate in nine (18%) and no effect in 1 (2%). Side effects were mild: Six patients (11%) experienced dizziness, one patient (2%) was considered drowsy. CONCLUSIONS Methoxyflurane is feasible as a first-line analgesic administered by a non-medical ski patrol in a responsibly organized system. Early pain management with inhalation of methoxyflurane provides good perceived effect with mild adverse events and can be of great value in settings where few alternatives for pain management are available.
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Affiliation(s)
| | - Lars Olav Fjose
- Innlandet Health Trust, Division of Prehospital Services, Gjøvik, Norway
- Norwegian Air Ambulance Foundation, Oslo, Norway
| | - Fridtjof Heyerdahl
- Norwegian Air Ambulance Foundation, Oslo, Norway.
- Air Ambulance Department, Oslo University Hospital, Oslo, Norway.
- University of Oslo, Institute of Clinical Medicine, Oslo, Norway.
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Methoxyflurane in Non-Life-Threatening Traumatic Pain-A Retrospective Observational Study. Healthcare (Basel) 2021; 9:healthcare9101360. [PMID: 34683042 PMCID: PMC8544466 DOI: 10.3390/healthcare9101360] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 10/06/2021] [Accepted: 10/12/2021] [Indexed: 11/17/2022] Open
Abstract
Pain management is a key issue in prehospital trauma. In Switzerland, paramedics have a large panel of analgesic options. Methoxyflurane was recently introduced into Switzerland, and the goal of this study was to describe both the effect of this medication and the satisfaction of its use. This was a retrospective cohort study, performed in one emergency ambulance service. It included adult patients with traumatic pain and a self-assessment of 3 or more on the visual analogue scale or verbal numerical rating scale. The primary outcome was the reduction in pain between the start of the care and the arrival at the hospital. Secondary outcomes included successful analgesia and staff satisfaction. From December 2018 to 4 June to October 2020, 263 patients were included in the study. Most patients had a low prehospital severity score. The median pain at arrival on site was 8 and the overall decrease in pain observed was 4.2 (95% CI 3.9–4.5). Regarding secondary outcomes, almost 60% had a successful analgesia, and over 70% of paramedics felt satisfied. This study shows a reduction in pain, following methoxyflurane, similar to outcomes in other countries, as well as the attainment of a satisfactory level of pain reduction, according to paramedics, with the advantage of including patients in their own care.
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Bussienne F, Reynaud T. Methoxyflurane May Be a Suitable Analgesic for Extreme Prehospital Conditions. Wilderness Environ Med 2021; 32:261-264. [PMID: 33839014 DOI: 10.1016/j.wem.2021.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 01/12/2021] [Accepted: 01/13/2021] [Indexed: 11/18/2022]
Affiliation(s)
- Frédéric Bussienne
- Department of Anaesthesia, University Hospital of Lausanne, Lausanne, Switzerland
| | - Thomas Reynaud
- Department of Anaesthesia, Hôpital de la Tour, Genève, Switzerland
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Brichko L, Gaddam R, Roman C, O’Reilly G, Luckhoff C, Jennings P, Smit DV, Cameron P, Mitra B. Rapid Administration of Methoxyflurane to Patients in the Emergency Department (RAMPED) Study: A Randomized Controlled Trial of Methoxyflurane Versus Standard Care. Acad Emerg Med 2021; 28:164-171. [PMID: 32989888 DOI: 10.1111/acem.14144] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 09/04/2020] [Accepted: 09/16/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The objective was to evaluate the effectiveness of methoxyflurane versus standard care for the initial management of severe pain among adult emergency department (ED) patients. METHODS This randomized parallel-group open-label phase IV trial of methoxyflurane was conducted in a tertiary hospital ED setting in Australia. Inclusion criteria required adult patients to have an initial pain score ≥ 8 on the 11-point Numerical Rating Scale (NRS). Patients were randomized 1:1 to receive either inhaled methoxyflurane (3 mL) or standard analgesic treatment at ED triage. The primary outcome was the proportion of patients achieving clinically substantial pain reduction, defined as a ≥50% drop in the pain score at 30 minutes. Secondary outcomes included the pain score at multiple time points (15, 30, 60, 90 minutes) and the difference in the proportion of patients achieving a >2-point reduction on the NRS. RESULTS There were 120 patients randomized and analyzed between September 4, 2019, and January 16, 2020. The primary outcome was achieved in six (10%) patients in the methoxyflurane arm and three (5%) in the standard care arm (p = 0.49). A higher proportion of patients in the methoxyflurane arm reported a >2-point drop on the NRS at all time points (17% vs. 5% at 15 minutes, 25% vs. 9% at 30 minutes, 30% vs. 10% at 60 minutes, and 33% vs. 13% at 90 minutes). Methoxyflurane use was also associated with lower median pain scores at all time points. CONCLUSION Initial management with inhaled methoxyflurane in the ED did not achieve the prespecified substantial reduction in pain, but was associated with clinically significant lower pain scores compared to standard therapy.
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Affiliation(s)
- Lisa Brichko
- From Emergency and Trauma Centre Alfred Health MelbourneAustralia
- School of Public Health & Preventive Medicine Monash MelbourneAustralia
- Emergency Department Cabrini Hospital MelbourneAustralia
| | - Ravali Gaddam
- From Emergency and Trauma Centre Alfred Health MelbourneAustralia
- Central Clinical School Monash MelbourneAustralia
| | - Cristina Roman
- From Emergency and Trauma Centre Alfred Health MelbourneAustralia
- Pharmacy Department Alfred Health MelbourneAustralia
- Centre for Medication Use and Safety Faculty of Pharmacy and Pharmaceutical Sciences Monash MelbourneAustralia
| | - Gerard O’Reilly
- From Emergency and Trauma Centre Alfred Health MelbourneAustralia
- School of Public Health & Preventive Medicine Monash MelbourneAustralia
- and National Trauma and Research Institute Alfred Health MelbourneAustralia
| | - Carl Luckhoff
- From Emergency and Trauma Centre Alfred Health MelbourneAustralia
| | - Paul Jennings
- School of Public Health & Preventive Medicine Monash MelbourneAustralia
- and Ambulance Victoria Melbourne Australia
- and Department of Paramedicine Monash University MelbourneAustralia
| | - De Villiers Smit
- From Emergency and Trauma Centre Alfred Health MelbourneAustralia
- School of Public Health & Preventive Medicine Monash MelbourneAustralia
- and National Trauma and Research Institute Alfred Health MelbourneAustralia
| | - Peter Cameron
- From Emergency and Trauma Centre Alfred Health MelbourneAustralia
- School of Public Health & Preventive Medicine Monash MelbourneAustralia
| | - Biswadev Mitra
- From Emergency and Trauma Centre Alfred Health MelbourneAustralia
- School of Public Health & Preventive Medicine Monash MelbourneAustralia
- and National Trauma and Research Institute Alfred Health MelbourneAustralia
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Rugg C, Woyke S, Voelckel W, Paal P, Ströhle M. Analgesia in adult trauma patients in physician-staffed Austrian helicopter rescue: a 12-year registry analysis. Scand J Trauma Resusc Emerg Med 2021; 29:28. [PMID: 33526048 PMCID: PMC7852148 DOI: 10.1186/s13049-021-00839-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 01/18/2021] [Indexed: 11/14/2022] Open
Abstract
Background Sufficient analgesia is an obligation, but oligoanalgesia (NRS> 3) is frequently observed prehospitally. Potent analgesics may cause severe adverse events. Thus, analgesia in the helicopter emergency medical service (HEMS) setting is challenging. Adequacy, efficacy and administration safety of potent analgesics pertaining to injured patients in HEMS were analysed. Methods Observational study evaluating data from 14 year-round physician-staffed helicopter bases in Austria in a 12-year timeframe. Results Overall, 47,985 (34.3%) patients received analgesics, 26,059 of whom were adult patients, injured and not mechanically ventilated on site. Main drugs administered were opioids (n=20,051; 76.9%), esketamine (n=9082; 34.9%), metamizole (n=798; 3.1%) and NSAIDs (n=483; 1.9%). Monotherapy with opioids or esketamine was the most common regimen (n=21,743; 83.4%), while opioids together with esketamine (n= 3591; 13.8%) or metamizole (n=369; 1.4%) were the most common combinations. Females received opioids less frequently than did males (n=6038; 74.5% vs. n=14,013; 78.1%; p< 0.001). Pain relief was often sufficient (> 95%), but females more often had moderate to severe pain on arrival in hospital (n=34; 5.0% vs. n=59; 3.2%; p=0.043). Administration of potent analgesics was safe, as indicated by MEES, SpO2 and respiratory rates. On 10% of all missions, clinical patient assessment was deemed sufficient by HEMS physicians and monitoring was spared. Conclusions Opioids and esketamine alone or in combination were the analgesics of choice in physician-staffed HEMS in Austria. Analgesia was often sufficient, but females more than males suffered from oligoanalgesia on hospital arrival. Administration safety was high, justifying liberal use of potent analgesics in physician-staffed HEMS. Supplementary Information The online version contains supplementary material available at 10.1186/s13049-021-00839-9.
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Affiliation(s)
- Christopher Rugg
- Department of Anaesthesiology and Critical Care Medicine, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Simon Woyke
- Department of Anaesthesiology and Critical Care Medicine, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Wolfgang Voelckel
- Department of Anaesthesiology and Intensive Care Medicine AUVA Trauma Centre Salzburg, Academic Teaching Hospital of the Paracelsus Medical University, Dr.-Franz-Rehrl-Platz 5, 5010, Salzburg, Austria
| | - Peter Paal
- Department of Anaesthesiology and Intensive Care Medicine, Hospitallers Brothers Hospital, Paracelsus Medical University, Kajetanerplatz 1, 5010, Salzburg, Austria.,Austrian Society for Mountain and High-altitude Medicine (ÖGAHM), Lehnrain 30a, 6414, Mieming, Austria
| | - Mathias Ströhle
- Department of Anaesthesiology and Critical Care Medicine, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria. .,Austrian Society for Mountain and High-altitude Medicine (ÖGAHM), Lehnrain 30a, 6414, Mieming, Austria.
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Fabbri A, Ruggiano G, Garcia Collado S, Ricard-Hibon A, Restelli U, Sbrana G, Marinangeli F, Farina A, Coffey F. Role of Inhaled Methoxyflurane in the Management of Acute Trauma Pain. J Pain Res 2020; 13:1547-1555. [PMID: 32612382 PMCID: PMC7323816 DOI: 10.2147/jpr.s252222] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 06/06/2020] [Indexed: 11/23/2022] Open
Abstract
Adequate treatment of trauma pain is an integral part of the management of trauma patients, not just for ethical reasons but also because undertreated pain can lead to increased morbidities and worse long-term outcomes. Trauma pain management presents challenges in the pre-hospital setting, particularly in adverse or hostile environments as well as in busy emergency departments (EDs). Inhaled methoxyflurane, administered at analgesic doses via a disposable inhaler, has recently become available in Europe for the emergency treatment of moderate to severe pain in conscious adult trauma patients. A growing body of evidence demonstrates that inhaled methoxyflurane is well tolerated and effective in providing a rapid onset of analgesia. In this paper, we discuss the rationale for methoxyflurane use in trauma pain management, data from clinical trials recently conducted in Europe, its efficacy and safety profile compared to current standard treatments, its place in therapy and organizational impact. We conclude that inhaled methoxyflurane represents an effective treatment option in the different settings where trauma patients require rapid and flexible pain resolution, with potential organizational advantages.
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Affiliation(s)
- Andrea Fabbri
- Department of Emergency Medicine, Morgagni-Pierantoni Hospital, Forlì, Italy
| | - Germana Ruggiano
- Emergency Medicine Department, Santa Maria Annunziata Hospital, Florence, Italy
| | | | - Agnes Ricard-Hibon
- Service SAMU-SMUR-SAU, GHT Nord Ouest Vexin Val d’Oise, Pontoise95, France
| | - Umberto Restelli
- Center for Health Economics, Social and Health Care Management, LIUC - Università Cattaneo, Castellanza, VA, Italy
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Giovanni Sbrana
- Anaesthesia, Intensive Care, Emergency Medicine, Grosseto HEMS, ASL Toscana Sud Est, Grosseto, Italy
| | - Franco Marinangeli
- Department of Anesthesiology and Intensive Care, University of L’Aquila, L’Aquila, Italy
| | - Alberto Farina
- Medical Affairs Department, Mundipharma Pharmaceuticals Srl, Milan, Italy
| | - Frank Coffey
- DREEAM - Department of Research and Education in Emergency Medicine Acute Medicine and Major Trauma, Nottingham University Hospitals’ NHS Trust, Nottingham, UK
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Voza A, Ruggiano G, Serra S, Carpinteri G, Gangitano G, Intelligente F, Bonafede E, Sblendido A, Farina A, Soldi A, Fabbri A. Inhaled Methoxyflurane versus Intravenous Morphine for Severe Trauma Pain in the Emergency Setting: Subgroup Analysis of MEDITA, a Multicenter, Randomized, Controlled, Open-Label Trial. J Pain Res 2020; 13:491-502. [PMID: 32184653 PMCID: PMC7064290 DOI: 10.2147/jpr.s240911] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 02/25/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose Opioid analgesics remain the cornerstone of treatment for severe trauma pain in the emergency setting, but there are barriers to their use. This post hoc analysis of a previously reported trial (MEDITA) investigated the efficacy and safety of low-dose methoxyflurane versus intravenous (IV) morphine for severe trauma pain. Patients and Methods MEDITA was a Phase IIIb, randomized, active-controlled, parallel-group, open-label study in Italian pre-hospital units and emergency departments (EudraCT: 2017-001565-25; NCT03585374). Adult patients (N=272) with moderate-to-severe trauma pain (score ≥4 on the Numerical Rating Scale [NRS]) were randomized 1:1 to inhaled methoxyflurane (3 mL) or standard analgesic treatment (SAT; IV paracetamol 1g or ketoprofen 100mg for moderate pain [NRS 4-6] and IV morphine 0.1mg/kg for severe pain [NRS ≥7]). Analyses were performed for the severe pain subgroup. The primary efficacy variable was the overall change from baseline in visual analog scale (VAS) pain intensity at 3, 5 and 10min post-randomization. Non-inferiority of methoxyflurane versus morphine was concluded if the upper 95% confidence interval (CI) for the treatment difference was <1; superiority was concluded if the upper 95% CI was <0. Results Ninety-three patients (methoxyflurane: 49; SAT: 44) were included in the severe pain intention-to-treat population. The reduction in VAS pain intensity over the first 10min was superior for methoxyflurane versus morphine (adjusted mean treatment difference: -5.54mm; 95% CI: -10.49, -0.59mm; p=0.029). Median time to onset of pain relief was 9min for methoxyflurane and 15min for morphine. Patients rated treatment efficacy and physicians rated treatment practicality "Excellent" or "Very good" for more methoxyflurane-treated patients (42.8% and 67.3%) than morphine-treated patients (18.1% and 22.8%). Adverse events, all non-serious, were reported in 20.4% of methoxyflurane-treated patients and in 4.8% of morphine-treated patients. Conclusion Methoxyflurane provided superior short-term pain relief to IV morphine in patients with severe trauma pain and offers an effective non-narcotic treatment option.
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Affiliation(s)
- Antonio Voza
- Emergency Department, IRCCS Humanitas Research Teaching Hospital, Milan, Italy
| | - Germana Ruggiano
- Emergency Medicine Department, Santa Maria Annunziata Hospital, Florence, Italy
| | - Sossio Serra
- Emergency Department, Maurizio Bufalini Hospital, Cesena, Italy
| | - Giuseppe Carpinteri
- Department of Emergency Medicine, Policlinico G. Rodolico University Hospital, Catania, Italy
| | | | - Fabio Intelligente
- Emergency Department, IRCCS Humanitas Research Teaching Hospital, Milan, Italy
| | | | | | - Alberto Farina
- Medical Affairs Department, Mundipharma Pharmaceuticals Srl, Milan, Italy
| | - Amedeo Soldi
- Medical Affairs Department, Mundipharma Pharmaceuticals Srl, Milan, Italy
| | - Andrea Fabbri
- Department of Emergency Medicine, Morgagni-Pierantoni Hospital, Forlì, Italy
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Mercadante S, Voza A, Serra S, Ruggiano G, Carpinteri G, Gangitano G, Intelligente F, Bonafede E, Sblendido A, Farina A, Soldi A, Fabbri A. Analgesic Efficacy, Practicality and Safety of Inhaled Methoxyflurane Versus Standard Analgesic Treatment for Acute Trauma Pain in the Emergency Setting: A Randomised, Open-Label, Active-Controlled, Multicentre Trial in Italy (MEDITA). Adv Ther 2019; 36:3030-3046. [PMID: 31612359 PMCID: PMC6822789 DOI: 10.1007/s12325-019-01055-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Indexed: 10/31/2022]
Abstract
INTRODUCTION Inhaled low-dose methoxyflurane is approved in Europe for emergency relief of moderate-to-severe trauma-related pain in adults, but data versus active comparators are sparse. The phase IIIb Methoxyflurane in Emergency Department in ITAly (MEDITA) trial investigated the analgesic efficacy, practicality and safety of methoxyflurane versus standard analgesic treatment (SAT) for acute trauma pain. METHODS This was a randomised, active-controlled, parallel-group, open-label trial conducted in 15 Italian emergency units. Adults with limb trauma and pain score ≥ 4 on numerical rating scale (NRS) were randomised 1:1 to inhaled methoxyflurane 3 mL or SAT [intravenously administered (IV) morphine 0.1 mg/kg for severe pain (NRS ≥ 7); IV paracetamol 1 g or IV ketoprofen 100 mg for moderate pain (NRS 4-6)]. The primary endpoint was overall change in visual analogue scale (VAS) pain intensity from baseline (time of randomisation) to 3, 5 and 10 min. Non-inferiority and superiority of methoxyflurane versus SAT were concluded if the upper 95% confidence interval (CI) for the treatment comparison (methoxyflurane-SAT) was less than 1 and less than 0, respectively. RESULTS Between 8 February 2018 and 8 February 2019, 272 patients were randomised (136 per treatment group). A total of 270 patients (mean age 51 years; 49% male; 34% with severe pain; mean baseline VAS 67 mm) were treated and analysed for efficacy and safety. Superiority of methoxyflurane was demonstrated for moderate-to-severe pain (adjusted mean treatment difference - 5.94 mm; 95% CI - 8.83, - 3.06 mm), moderate pain (- 5.97 mm; 95% CI - 9.55, - 2.39 mm) and severe pain (- 5.54 mm; 95% CI - 10.49, - 0.59 mm). Median onset of pain relief was 9 min for methoxyflurane and 15 min for SAT. Practicality of methoxyflurane treatment was rated "Excellent", "Very Good" or "Good" by 90% of clinicians vs. 64% for SAT. Adverse events (all non-serious) were reported by 17% of methoxyflurane-treated patients and 3% of SAT-treated patients. CONCLUSION Methoxyflurane provided superior pain relief to SAT in patients with moderate-to-severe trauma pain and may offer a simple, fast, effective non-opioid treatment option. TRIAL REGISTRATION Trial registered with EudraCT (2017-001565-25) on 2 March 2018 and ClinicalTrials.gov (NCT03585374) on 13 July 2018. FUNDING Mundipharma Pharmaceuticals S.r.l.
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Affiliation(s)
- Sebastiano Mercadante
- Main Regional Center for Pain Relief and Supportive/Palliative Care, La Maddalena Cancer Center, Palermo, Italy
| | - Antonio Voza
- Emergency Department, IRCCS Humanitas Research Teaching Hospital, Rozzano, Milan, Italy
| | - Sossio Serra
- Emergency Department, Maurizio Bufalini Hospital, Cesena, Italy
| | - Germana Ruggiano
- Emergency Medicine Department, Santa Maria Annunziata Hospital, Florence, Italy
| | - Giuseppe Carpinteri
- Department of Emergency Medicine, Policlinico G. Rodolico University Hospital, Catania, Italy
| | | | - Fabio Intelligente
- Emergency Department, IRCCS Humanitas Research Teaching Hospital, Rozzano, Milan, Italy
| | | | - Antonella Sblendido
- Medical Affairs Department, Mundipharma Pharmaceuticals S.r.l., Milan, Italy
| | - Alberto Farina
- Medical Affairs Department, Mundipharma Pharmaceuticals S.r.l., Milan, Italy
| | - Amedeo Soldi
- Medical Affairs Department, Mundipharma Pharmaceuticals S.r.l., Milan, Italy
| | - Andrea Fabbri
- Department of Emergency Medicine, Morgagni-Pierantoni Hospital, Forlì, Italy.
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Rahman SM, Quinn E. BET 1: Green or blue for you? Methoxyflurane (Penthrox) or nitrous oxide/oxygen 50% mixture (Entonox) for the management of acute pain in the ED. Emerg Med J 2019; 36:506-508. [DOI: 10.1136/emermed-2019-208777.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
A short-cut review of the literature was carried out to establish whether inhaled methoxyflurane (Penthrox) is comparable or superior with a standard inhalational analgesia for the management of acute pain. Only two papers were identified as suitable for inclusion using the reported search strategy. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of the best papers are tabulated. It is concluded that both methods of inhaled analgesia appear to be useful options for acute pain in the ED when compared with placebo. No evidence was found to suggest superiority of methoxypenflurane. International studies directly comparing the use of both drugs for in acute trauma are ongoing and will develop the evidence base.
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