Inhaled methoxyflurane and intranasal fentanyl for prehospital management of visceral pain in an Australian ambulance service

Johnston, Steven; Wilkes, Garry J; Thompson, Jennifer A.; Ziman, Mel; Brightwell, Richard

doi:10.1136/emj.2009.078717

Cited by 54 publications

(45 citation statements)

References 27 publications

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“…Co-therapy using more than one of the three agents (IN fentanyl, IV morphine, inhaled methoxyflurane) in any combination has been previously shown to be no more effective than IN fentanyl or IV morphine alone. 3,7 Methoxyflurane accounts for more than half of cases in which a single agent is used. This is not unexpected given that all paramedics in this jurisdiction can administer methoxyflurane, and that opiates are restricted to Qualified Paramedics and Intensive Care Paramedics.…”

Section: Discussionmentioning

confidence: 99%

Prehospital Analgesia in New South Wales, Australia

Bendall

Simpson

Middleton

2011

Prehosp. Disaster med.

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In this ambulance service, analgesia most often is provided through the use of a single agent. The majority of patients receive non-opioid analgesia with methoxyflurane, most likely because all levels of paramedics are authorized to administer that analgesic. Females and children are less likely to receive opiate-based analgesia than their male and adult counterparts, respectively. Paramedics appear to favor intranasal opiate delivery over intravenous delivery in children with acute pain.

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Section: Discussionmentioning

confidence: 99%

Prehospital Analgesia in New South Wales, Australia

Bendall

Simpson

Middleton

2011

Prehosp. Disaster med.

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“…However the literature is sparse and conflicting as to its advantages. For example, in one study, IN fentanyl and methoxyflurane were no better than IN fentanyl alone ( Johnston et al, 2011). In another study, morphine combined with ketamine was advantageous in terms of morphine sparing, but at the expense of more side effects (Galinski et al, 2007;Jennings et al, 2012).…”

Section: Is a Multimodal Drug Approach Supported By Literature?mentioning

confidence: 99%

“…However, pain relief is inferior to IV morphine or IN fentanyl ( Johnston et al, 2011;Middleton et al, 2011). When peripheral IV access is difficult, other parenteral routes including intraosseous (IO) and intramuscular (IM) can be utilized.…”

Section: Does Prehospital Analgesia Influence Outcome?mentioning

confidence: 99%

Managing Moderate and Severe Pain in Mountain Rescue

Ellerton¹,

Milani

Blancher

et al. 2014

High Altitude Medicine & Biology

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Many health care providers fail to recognize, assess, and treat pain adequately. Assessment scales and treatment protocols should be implemented in mountain rescue services to encourage better management of pain. Specific training in assessing and managing pain is essential for all mountain rescuers. Persons administrating analgesics should receive appropriate detailed training. There is no ideal analgesic that will accomplish all that is expected in every situation. A range of drugs and delivery methods will be needed. Thus, an 'analgesic module' reflecting its users and the environment should be developed. The number of drugs carried should be reduced to a minimum by careful selection and, where possible, utilizing drugs with multiple delivery options. A strong opioid is recommended as the core drug for managing moderate or severe pain; a multimodal approach may provide additional benefits.

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“…Intranasal preparations have been well researched as potential alternate means to deliver adequate pain control to prehospital and ED patients [7][8][9][10][11]. However, this method is limited in the total dose of analgesia that can be administered and is reported to have a delayed onset of analgesia when compared to IV administration [12].…”

Section: Introductionmentioning

confidence: 99%