References

Blair HA, Frampton JE Methoxyflurane: a review in trauma pain. Clin Drug Invest. 2016; 36:(12)1067-1073 https://doi.org/10.1007/s40261-016-0473-0

Coffey F, Wright J, Hartshorn S STOP!: a randomised, double-blind, placebo-controlled study of the efficacy and safety of methoxyflurane for the treatment of acute pain. Emerg Med J. 2014; 31:(8)613-618 https://doi.org/10.1136/emermed-2013-202909

Cousins MJ, Mazze RI Methoxyflurane nephrotoxicity: a study of dose response in man. JAMA. 1973; 225:1611-1616 https://doi.org/10.1001/jama.1973.03220410023005

Crandell WB, Pappas SG, Macdonald A Nephrotoxicity associated with methoxyflurane anaesthetic. Anesthesiology. 1966; 27:591-607 https://doi.org/10.1097/00000542-196609000-00010

Dale J, Bjørnsen LP Assessment of pain in a Norwegian Emergency Department. Scand J Trauma Resusc Emerg Med. 2015; 23 https://doi.org/10.1186/s13049-015-0166-3

Dayan AD Analgesic use of inhaled methoxyflurane: evaluation of its potential nephrotoxicity. Hum Exp Toxicol. 2016; 35:91-100 https://doi.org/10.1177/0960327115578743

Electronic Medicines Compendium. Penthrox 99.9%, 3 ml inhalation vapour, liquid. EMC: 2018. Summary of product characteristics. http//www.medicines.org.uk/emc/medicine/31391

Frangos J, Mikkonen A, Down C Derivation of an occupational exposure limit for an inhalation analgesic methoxyflurane (Penthrox®). 2016; 80:210-225 https://doi.org/10.1016/j.yrtph.2016.05.012

Guéant S, Taleb A, Borel-Kühner J Quality of pain management in the emergency department: results of a multicentre prospective study. Eur J Anaesthesiol. 2011; 28:97-105 https://doi.org/10.1097/EJA.0b013e3283418fb0

Griffiths E Efficacy and safety of methoxyflurane: managing trauma associated pain in UK SAR helicopter paramedic practice. J Paramedic Pract. 2017; 9:(3)108-120 https://doi.org/10.12968/jpar.2017.9.3.108

Jephcott C, Grummet J, Nguyen N, Spruyt O A review of the safety and efficacy of inhaled methoxyflurane as an analgesic for outpatient procedures. Brit J Anaes. 2018; 120:(5)1040-1048 https://doi.org/10.1016/j.bja.2018.01.011

Medical Developments International. Penthrox® (methoxyflurane) inhalation product information. 2016. http//www.medicaldev.com/wp-content/uploads/2017/03/Penthrox-PI-v13-Leaflet.pdf (accessed 5 January 2019)

Medicines and Healthcare Products Regulatory Agency. Penthrox 3 ml inhalation vapour, liquid (methoxyflurane). 2017. http//tinyurl.com/ya4jplf3 (accessed 5 January 2019)

Oxer HF Effects of Penthrox (methoxyflurane) as an analgesic on cardiovascular and respiratory function in the prehospital setting. J Mil Veterans Health. 2016; 24:(2)14-20

Pierik JG, IJzerman MJ, Gaakeer MI Pain management in the emergency chain: the use and effectiveness of pain management in patients with acute musculoskeletal pain. Pain Med. 2015; 16:970-984 https://doi.org/10.1111/pme.12668

Thomas SH Management of pain in the emergency department. ISRN Emerg Med. 2013; https://doi.org/10.1155/2013/583132

Tomlin PJ Methoxyflurane. Br J Anaesth. 1965; 37:706-9 https://doi.org/10.1093/bja/37.9.706

Ventafridda V, Saita L, Ripamonti C, De Conno F WHO guidelines for the use of analgesics in cancer pain. Int J Tissue React. 1985; 7:(1)93-96

case study
medications
prehospital
pain management

Methoxyflurane (Penthrox®)—a case series of use in the prehospital setting

02 February 2019
Features
02 February 2019
Volume 11 · Issue 2

Abstract

Methoxyflurane (Penthrox®) is a fluorinated hydrocarbon, which when first used in general anaesthesia was noted to have strong analgesic properties in subanaesthetic dosage. More than 5 million doses have been sold for use in Australia since 1978 and have been found to have an excellent safety profile. After rigorous review by the Medicines and Healthcare Regulatory Agency, methoxyflurane was granted a product licence in 2015 in the UK and Europe for the relief of pain in patients with moderate-to-severe trauma. This paper presents the first reported case series of patients treated with methoxyflurane in the UK and Ireland in the prehospital environment. The results show a statistically significant improvement in patient pain scores at 1, 2 and 5 minutes following administration of methoxyflurane. With its use increasing in prehospital care and emergency departments, methoxyflurane is recognised as a useful adjunct to the choice of analgesia for trauma patients with moderate-to-severe pain.

Despite advances in pain medication and widely accepted guidelines for the treatment of pain, such as the World Health Organization (WHO) analgesic ladder (Ventafridda et al, 1985), inadequate assessment and management of acute pain remains common in prehospital and emergency department (ED) settings (Guéant et al, 2011; Dale et al, 2015; Pierik et al, 2015). Poor or slow pain management practices can have a negative impact on patient care, patient-reported outcomes and patient flow (Thomas, 2013).

Methoxyflurane belongs to the fluorinated hydrocarbon group of volatile anaesthetics (Tomlin et al, 1965). As with all anaesthetics, the precise mechanism of action is unclear. Methoxyflurane is unique in this anaesthetic family in having well-documented analgesic properties at low doses (Blair et al, 2016; Jephcott et al, 2018).

Subscribe to get full access to the Journal of Paramedic Practice

Thank you for visiting the Journal of Paramedic Practice and reading our archive of expert clinical content. If you would like to read more from the only journal dedicated to those working in emergency care, you can start your subscription today for just £48.

What's included

  • CPD Focus

  • Develop your career

  • Stay informed

Register
Or continue by

Signing in with your registered email address

Trauma
Pain
Inhaled analgesic
Methoxyflurane
Penthrox