1. Methoxyflurane was more effective in achieving faster pain reduction in a prehospital trauma setting compared to usual analgesic practices involving Entonox, intravenous morphine, and intravenous paracetamol.
Evidence Rating Level: 2 (Good)
Acute pain secondary to prehospital injury is frequently managed by Emergency Medical Service personnel; however, pain has been shown to be often inadequately treated. Usual analgesic practice for trauma pain in a prehospital setting includes opioids, paracetamol, Entonox (inhalation analgesic mixture of nitric oxide and oxygen), and non-steroidal anti-inflammatory medications. Barriers to pain management include incorrect pain assessments, limited choices of analgesics, and contraindications to effective pharmaceutical options. Methoxyflurane is a fluorinated hydrocarbon anesthetic that is easy to administer via inhaler, has a good safety profile, and is widely used as an inhalational analgesic in Australia. Despite this, there is limited evidence regarding the clinical and cost effectiveness of methoxyflurane in the prehospital environment. In this non-randomized clinical study, the benefits and economic costs of adding methoxyflurane to prehospital analgesic protocol was assessed in comparison to Entonox, intravenous morphine, and intravenous paracetamol. Overall, 483 patients were administered methoxyflurane and comparison data of patients using Entonox, intravenous morphine, and intravenous paracetamol was obtained from pre-existing ambulance service databases. The time to achieve maximum pain relief was significantly shorter in patients using methoxyflurane (26.5 minutes, 95%CI 24.9-27.9) compared to Entonox (44.4 minutes, 95%CI 39.5-49.3), intravenous morphine (41.8 minutes, 95%CI 38.9-44.7), and intravenous paracetamol (40.8 minutes, 95%CI 34.7-46.9). In addition, methoxyflurane was easy to administer for most patients and number of adverse events were low. In conclusion, methoxyflurane appears to be effective in achieving faster pain reduction compared to usual analgesic practices, in a prehospital setting. These findings will have significant implications for pain management in a prehospital, trauma environment where speed of stabilization is of utmost importance. Further research using randomized controlled designs directly comparing methoxyflurane to the current gold standards can be crucial in optimizing acute pain treatment in the future.
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