Comparison of inhalational methoxyflurane (Penthrox®) and intramuscular tramadol for prehospital analgesia

Lim, Kegan Jianhong; Koh, Zhi Xiong; Ng, Yih Yng; Fook‐Chong, S.; Ho, Andrew Fu Wah; Doctor, Nausheen Edwin; Said, Nur Ain Zafirah Mohd; Ong, Marcus Eng Hock

doi:10.11622/smedj.2020035

Cited by 10 publications

(10 citation statements)

References 19 publications

(20 reference statements)

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“…In the prehospital setting comparing methoxyflurane with intramuscular tramadol in a cluster randomised cross-over trial for people with moderate to severe pain due to musculoskeletal trauma in Singapore, methoxyflurane was superior to tramadol in efficacy, speed of onset and administration, but with more minor adverse effects [ 23 ].…”

Section: Discussionmentioning

confidence: 99%

Evaluation of the effectiveness and costs of inhaled methoxyflurane versus usual analgesia for prehospital injury and trauma: non-randomised clinical study

et al. 2022

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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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Section: Discussionmentioning

confidence: 99%

Evaluation of the effectiveness and costs of inhaled methoxyflurane versus usual analgesia for prehospital injury and trauma: non-randomised clinical study

et al. 2022

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“…Despite the extensive use of methoxyflurane in Australia and New Zealand for 40 years, only a few studies [18][19][20][21] have tested methoxyflurane with active comparators for acute pain management in patients with trauma. In the prehospital settings, a large retrospective study showed the analgesic effect of methoxyflurane was inferior to IV morphine and intranasal fentanyl, 18 whereas one randomized controlled trial versus intramuscular tramadol showed that methoxyflurane resulted in a significantly greater and faster reduction in pain score.…”

Section: Discussionmentioning

confidence: 99%

A randomized non‐inferiority pilot study on the use of methoxyflurane (Penthrox^®) for pain control in the emergency department

Wong

Lau

Siu

2022

Hong Kong j. emerg. med.

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Background: Patients commonly visit the emergency department for pain after musculoskeletal injury, but the problem of oligoanalgesia is prevalent. Methoxyflurane (Penthrox®) is an inhalational analgesic for moderate to severe trauma-associated pain in stable and conscious patients. It is a fast-acting, effective analgesic that can be readily administered via a non-invasive route, making it an attractive agent for managing acute pain in the emergency departments. Objectives: The aim was to assess the analgesic efficacy of methoxyflurane in patients with acute traumatic pain by comparing it to ketorolac, a standard analgesic treatment for moderate pain in emergency departments in Hong Kong. Methods: This was a single-center, open-label, randomized controlled, parallel-group, non-inferiority pilot study that enrolled adult patients with moderate trauma-associated pain in an emergency department in Hong Kong. Patients were randomized 1:1 to the methoxyflurane group or the ketorolac group. The primary outcome was the change in pain intensity measured by visual analogue scale from baseline to 5, 15, 30, and 60 min after drug administration. Results: Twenty patients received methoxyflurane, and twenty patients received ketorolac. There were significant reductions in pain score over 60 min in both groups. The pain reduction at 5 min was significantly greater for the methoxyflurane group (−13.912 mm; 95% confidence interval = −20.008 to −7.817) than for the ketorolac group (−4.888 mm; 95% confidence interval = −10.983 to 1.208), with the treatment effect (−9.025 mm; 95% confidence interval = −17.656 to −0.393; p = 0.041) demonstrating superiority of methoxyflurane. The treatment effect at 15 and 30 min demonstrated non-inferiority of methoxyflurane versus ketorolac. Conclusion: Methoxyflurane provided non-inferior analgesia in the first 30 min with a faster onset of action when compared with ketorolac in moderate traumatic pain. It can be considered a non-invasive, rapid-acting, and effective first-line alternative to currently available analgesics for traumatic pain in emergency settings.

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“…Although Low-dose Penthrox Inhaler (3 ml) can be simply given, it also quickly reduces pain compared to the administration of analsegic drugs by injection (Mercadante et al, 2019).Penthrox Inhaler inhalation gives a faster effect on pain reduction compared to Tramadol injection, Tramadol is an analgesic drug that is given by injection into the intramuscular (Lim et al, 2020).…”

Section: Picture 2:-workflow Penthrox Inhalermentioning

confidence: 99%

Pain Management With Penthrox Inhaler in Prehospital Care:literature Review

Setiaman¹,

Peristiowati²,

Ellina³

2021

IJAR

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Introduction:Traumas that give symptoms of severe pains could lead to stress induced pain if not given an immediate pain relief. Penthroxinhaler an immediate pain reliever, can be given in pre-hospital services by ambulance officers (paramedics or ambulance nurses). Penthroxinhaler is a low-dose Methoxyflurane single-use inhaler, and has been used for more than 40 years in the medical field in managing trauma pain. Aim:The purpose of this study was to explore the original research related to the prospects of trauma pain management with Penthrox Inhaler, the benefits of using Penthrox inhaler in pre-hospital trauma pain management, and to identify the side effects from using Penthrox Inhaler based on researches published in international journals. Method:The method used in this literature review is the PICO method a type of systematic literature review. Problem/patient: Severe pain. Intervention: Penthrox Inhaler, Comparison: none. Outcome: Pain relief, Keyword : Pain relief. Result:The administration of Low Dose Methoxyflurane in cases of trauma pain showed a very significant effect.GivingLow Dose Methoxyflurane was given faster to the patientcompared to other drugs. With the provision of LDM, the pain reduction was with a VAS value, which stated very satisfying by 42.8% and satisfying 67.3%. The side effects of using gas drugs are generally seen, whether it causes neprotoxicity and the level of tolerability by the patient himself.Before giving Methoxyflurane to patients, must ensure that the oxygen saturation level is above 90% and the maximum dosage given must be 6 ml in the span of 2 hours to reduce side effects.Ambulance officers can be safe with an exposure time of 8 hours while administering Penthrox to patients.

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Comparison of inhalational methoxyflurane (Penthrox®) and intramuscular tramadol for prehospital analgesia

Cited by 10 publications

References 19 publications

Evaluation of the effectiveness and costs of inhaled methoxyflurane versus usual analgesia for prehospital injury and trauma: non-randomised clinical study

Evaluation of the effectiveness and costs of inhaled methoxyflurane versus usual analgesia for prehospital injury and trauma: non-randomised clinical study

A randomized non‐inferiority pilot study on the use of methoxyflurane (Penthrox^®) for pain control in the emergency department

Pain Management With Penthrox Inhaler in Prehospital Care:literature Review

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Comparison of inhalational methoxyflurane (Penthrox®) and intramuscular tramadol for prehospital analgesia

Cited by 10 publications

References 19 publications

Evaluation of the effectiveness and costs of inhaled methoxyflurane versus usual analgesia for prehospital injury and trauma: non-randomised clinical study

Evaluation of the effectiveness and costs of inhaled methoxyflurane versus usual analgesia for prehospital injury and trauma: non-randomised clinical study

A randomized non‐inferiority pilot study on the use of methoxyflurane (Penthrox®) for pain control in the emergency department

Pain Management With Penthrox Inhaler in Prehospital Care:literature Review

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A randomized non‐inferiority pilot study on the use of methoxyflurane (Penthrox^®) for pain control in the emergency department