<p>Role of Inhaled Methoxyflurane in the Management of Acute Trauma Pain</p>

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.

Does Inhaled Methoxyflurane Implement Fast and Efficient Pain Management in Trauma Patients? A Systematic Review and Meta-Analysis

“…Our findings demonstrate an increased risk of TEAEs, especially central nervous system-type reactions such as dizziness, somnolence, and feeling drunk that are associated with the administration of methoxyflurane [24]. This finding is consistent with that of most current RCTs examining the efficacy of methoxyflurane in trauma pain [14-17, 20, 21].…”

“…This difference has been defined to be a 1.3-to 1.5-cm change at a single time point for ED patients [39,40]. Although not rigorously established, for the outcome of time from the start of treatment to first pain relief, we used a 4-min difference to interpret the treatment effect [24,26].…”

“…In addition to being safe, the cost-effective implications of methoxyflurane should also be considered [24]. Some clinicians may not administer methoxyflurane because of the high costs and a lack of clear clinical benefits, while others may choose to administer methoxyflurane for traumas that are easy to treat (e.g.,, dislocations and fractures) [24]. It has been finitely documented that the administration of inhaled methoxyflurane reduces the use of human resources and consumables compared to SAT [24,53].…”

“…Several previously published reviews examining the effect of methoxyflurane have suggested benefit in ED patients, but definitive conclusions are limited by imprecision and non-quantitative analysis [24][25][26]. A recently published article only summarized the completed or ongoing main studies in Europe without performing a systematic literature review [24]. In addition, the results of methoxyflurane-related adverse reactions in trauma patients are controversial, with conflicting trial results [13,14,20,21].…”

Why don’t we have better pain treatments?

“…The long dissipation time that was a limitation on its use as an anesthetic became a strength of the agent as an analgesic as its effect continued for 30 minutes after administration. Its onset is much faster than anything but an IV analgesic, and after 6,000,000 cases very few safety issues have been identified, including no reports of addiction or abuse 5,9 . In 2004, however, the FDA issued a statement that since it had been withdrawn due to issues of safety, and the efficacy displayed in studies at that point was so marginal, that it would not consider any abbreviated new drug applications, which are usually used for review and approval of generic drugs, that refer to this drug 8…”