ANalgesic Efficacy and safety of MOrphiNe versus methoxyflurane in patients with acute myocardial infarction: the rationale and design of the ANEMON-SIRIO 3 study: a multicentre, open-label, phase II, randomised clinical trial

Kubica, Aldona; Kosobucka, Agata; Niezgoda, Piotr; Adamski, Piotr; Buszko, Katarzyna; Lesiak, Maciej; Wojakowski, Wojciech; Gąsior, Mariusz; Gorący, Jarosław; Kleinrok, Andrzej; Nadolny, Klaudiusz; Navarese, Eliano Pio; Kubica, Jacek

doi:10.1136/bmjopen-2020-043330

Cited by 4 publications

(2 citation statements)

References 30 publications

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“…Methoxyflurane, a volatile anaesthetic from the group of the di-alkyl esters (2-dichloro-1:1-difluoroethyl-methyl-ester) has been used at low, purely analgesic concentrations by paramedics in Australia (Penthrox®) since 1975, in New Zealand since 2002 and in several eastern European countries since 2010 [17][18][19][20][21][22]. By now, inhaled methoxyflurane has been studied in more than 200,000 adults and paediatric patients in registry data and prospective trials [19,23,24].…”

Section: Introductionmentioning

confidence: 99%

Usability and effectiveness of inhaled methoxyflurane for prehospital analgesia - a prospective, observational study

Trimmel

Egger²,

Doppler³

et al. 2022

BMC Emerg Med

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Background Pain relief in the prehospital setting is often insufficient, as the administration of potent intravenous analgesic drugs is mostly reserved to physicians. In Australia, inhaled methoxyflurane has been in routine use by paramedics for decades, but experience in Central European countries is lacking. Thus, we aimed to assess whether user friendliness and effectiveness of inhaled methoxyflurane as sole analgesic match the specific capabilities of local ground and air-based EMS systems in Austria. Methods Observational study in adult trauma patients (e.g. dislocations, fracture or low back pain following minor trauma) with moderate to severe pain (numeric rating scale [NRS] ≥4). Included patients received a Penthrop® inhaler containing 3 mL of methoxyflurane (maximum use 30 min). When pain relief was considered insufficient (NRS reduction < 3 after 10 min), intravenous analgesics were administered by an emergency physician. The primary endpoint was effectiveness of methoxyflurane as sole analgesic for transport of patients. Secondary endpoints were user friendliness (EMS personell), time to pain relief, vital parameters, side effects, and satisfaction of patients. Results Median numeric pain rating was 8.0 (7.0–8.0) in 109 patients. Sufficient analgesia (reduction of NRS ≥3) was achieved by inhaled methoxyflurane alone in 67 patients (61%). The analgesic effect was progressively better with increasing age. Side effects were frequent (n = 58, 53%) but mild. User satisfaction was scored as very good when pain relief was sufficient, but fair in patients without benefit. Technical problems were observed in 16 cases (14.7%), mainly related to filling of the inhaler. In every fifth use, the fruity smell of methoxyflurane was experienced as unpleasant. No negative effects on vital signs were observed. Conclusion In prehospital use, inhaled methoxyflurane as sole analgesic is effective for transport of trauma patients (62%) with moderate to severe pain. Older patients benefit especially from inhaled methoxyflurane. Side effects are mild and vital parameters unaffected. Thus, inhaled methoxyflurane could be a valuable device for non-physician EMS personnel rescue services also in the central Europe region.

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Section: Introductionmentioning

confidence: 99%

Usability and effectiveness of inhaled methoxyflurane for prehospital analgesia - a prospective, observational study

Trimmel

Egger²,

Doppler³

et al. 2022

BMC Emerg Med

View full text Add to dashboard Cite

show abstract

“…In a metaanalysis by Gue et al [10], patients pretreated with morphine were shown to have a higher rate of reinfarction than those not receiving morphine. Several approaches to overcome the "morphine effect" in patients with ACS have been proposed, showing some, but unsatisfactory effects [11][12][13][14][15][16]. Iglesias et al [17] reported results of the PERSEUS studya randomized trial comparing the impact of fentanyl versus morphine on ticagrelor pharmacokinetics and pharmacodynamics in STEMI patients undergoing primary percutaneous coronary intervention (PCI).…”

mentioning

confidence: 99%