Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Jan 20:14:93-105.
doi: 10.2147/JPR.S292521. eCollection 2021.

Low-Dose Methoxyflurane versus Standard of Care Analgesics for Emergency Trauma Pain: A Systematic Review and Meta-Analysis of Pooled Data

Andrea Fabbri  1 , Alberto M Borobia  2 , Agnes Ricard-Hibon  3 , Frank Coffey  4 , Aurore Caumont-Prim  5 , François Montestruc  5 , Amedeo Soldi  6 , Susana Traseira Lugilde  7 , Sara Dickerson  8
Affiliations

Low-Dose Methoxyflurane versus Standard of Care Analgesics for Emergency Trauma Pain: A Systematic Review and Meta-Analysis of Pooled Data

Andrea Fabbri et al. J Pain Res. .

Abstract

Purpose: Undertreatment of trauma-related pain is common in the pre-hospital and hospital settings owing to barriers to the use of traditional standard of care analgesics. Low-dose methoxyflurane is an inhaled non-opioid analgesic with a rapid onset of pain relief that is approved for emergency relief of moderate-to-severe trauma-related pain in adults. This analysis was performed to compare the efficacy and safety of low-dose methoxyflurane with standard of care analgesics in adults with trauma-related pain.

Methods: A meta-analysis was performed on pooled data from randomized controlled trials identified via a systematic review. The primary endpoint was the pain intensity difference between baseline and various time intervals (5, 10, 15, 20, and 30 minutes) after initiation of treatment.

Results: The pain intensity difference was statistically superior with low-dose methoxyflurane compared with standard of care analgesics (overall estimated treatment effect=11.88, 95% CI=9.75-14.00; P<0.0001). The superiority of low-dose methoxyflurane was demonstrated at 5 minutes after treatment initiation and was maintained across all timepoints. Significantly more patients treated with methoxyflurane achieved response criteria of pain intensity ≤30 mm on a visual analog scale, and relative reductions in pain intensity of ≥30% and ≥50%, compared with patients who received standard of care analgesics. The median time to pain relief was shorter with methoxyflurane than with standard of care analgesics. The findings were consistent in a subgroup of elderly patients (aged ≥65 years).

Conclusion: Methoxyflurane can be considered as an alternative to standard of care analgesics in pre-hospital and hospital settings for treatment of adult patients with acute trauma-related pain.

Keywords: acute pain; analgesia; emergency service; inhaled analgesic; pain management; wounds and injury.

PubMed Disclaimer

Conflict of interest statement

Dr Fabbri has received fees from Mundipharma as a member of the scientific committee for the MEDITA study, and was corresponding author for that study. Dr Borobia has received fees from Mundipharma as a member of the scientific committee for InMEDIATE, as well as speaker fees from Mundipharma and Menarini. Dr Borobia is Principal Investigator on clinical trials sponsored by GSK, Daiichi Sankyo, Janssen and Farmalider. Dr Ricard-Hibon has served as an advisory board member for Mundipharma. Professor Coffey was chief investigator for the STOP! Study and has received honoraria to present at symposia sponsored by Mundipharma. Aurore Caumont-Prim and François Montestruc are employees of eXYSTAT, a contract research organization which received fees from Mundibiopharma Limited to perform the meta-analysis. Amedeo Soldi is an employee of Mundipharma Srl. Susana Traseira Lugilde is an employee of Mundipharma S.L. Sara Dickerson is an employee of Mundibiopharma Limited. The authors report no other conflicts of interest in this work.

Figures

Figure 1
Figure 1
PRISMA flow diagram for study selection.
Figure 2
Figure 2
Pain intensity difference repeated measures ANOVA (MAP1).
Figure 3
Figure 3
Treatment satisfaction.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. European Society for Emergency Medicine. Guidelines for the management of acute pain in emergency situations; 2020. Available from: https://www.eusem.org/images/EUSEM_EPI_GUIDELINES_MARCH_2020.pdf. Accessed September23, 2020.
    1. Albrecht E, Taffe P, Yersin B, Schoettker P, Decosterd I, Hugli O. Undertreatment of acute pain (oligoanalgesia) and medical practice variation in prehospital analgesia of adult trauma patients: a 10 yr retrospective study. Br J Anaesth. 2013;10:96–106. doi:10.1093/bja/aes355 - DOI - PubMed
    1. Dale J, Bjørnsen LP. Assessment of pain in a Norwegian Emergency Department. Scand J Trauma Resusc Emerg Med. 2015;23:86. doi:10.1186/s13049-015-0166-3 - DOI - PMC - PubMed
    1. Mura P, Serra E, Marinangeli F, et al. Prospective study on prevalence, intensity, type, and therapy of acute pain in a second-level urban emergency department. J Pain Res. 2017;10:2781–2788. doi:10.2147/JPR.S137992 - DOI - PMC - PubMed
    1. Sokoloff C, Daoust R, Paquet J, Chauny J-C. Is adequate pain relief and time to analgesia associated with emergency department length of stay? A retrospective study. BMJ Open. 2014;4(3):e004288. doi:10.1136/bmjopen-2013-004288 - DOI - PMC - PubMed

LinkOut - more resources