Borobia AM, Collado SG, Cardona CC, et al. Inhaled Methoxyflurane Provides Greater Analgesia and Faster Onset of Action Versus Standard Analgesia in Patients With Trauma Pain: InMEDIATE: A Randomized Controlled Trial in Emergency Departments. Ann Emerg Med. 2019 Oct 14. pii: S0196-0644(19)30614-6. doi: 10.1016/j.annemergmed.2019.07.028. (Original study)

STUDY OBJECTIVE: The objective of the InMEDIATE study was to evaluate the change in intensity of traumatic pain over the first 20 min in adult patients treated with methoxyflurane versus standard analgesic treatment in Spain. This the first randomized, active-controlled, multicenter trial of methoxyflurane in the emergency setting in Europe.

METHODS: This was a randomized, controlled study that enrolled adult patients with acute moderate to severe (score =4 on the 11-point Numeric Rating Scale) trauma-associated pain in 14 Spanish emergency departments. Patients were randomized 1:1 to methoxyflurane (up to 2×3 mL) or standard analgesic treatment. Coprimary endpoints were the change from baseline in Numeric Rating Scale pain intensity score during the first 20 minutes of treatment and time to first pain relief.

RESULTS: Three hundred five patients were randomized (methoxyflurane 156; standard analgesic treatment 149). Most patients in the standard analgesic treatment group (70%) received intravenous first-step analgesics and 9.4% of patients were treated with opioids. Mean decrease from baseline in Numeric Rating Scale pain intensity score was greater for methoxyflurane than standard analgesic treatment at all points, with a significant treatment difference overall up to 20 minutes (repeated-measures model 2.47 versus 1.39; treatment difference 1.00; 95% confidence interval 0.84 to 1.32). Median time to first pain relief was significantly shorter for methoxyflurane than standard analgesic treatment (3 versus 10 minutes). Methoxyflurane achieved better patient and clinician ratings for pain control and comfort of treatment than standard analgesic treatment and exceeded patient and clinician expectations of treatment in, respectively, 77% and 72% of cases compared with 38% and 19% for standard analgesic treatment.

CONCLUSION: These results support consideration of methoxyflurane as a nonnarcotic, easy-to-administer, rapid-acting, first-line alternative to currently available analgesic treatments for trauma pain.

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Comments from MORE raters

Physician rater

This study suggests that an inhaled low dose of an anesthetic offers promise in terms of rapid administration of analgesia to trauma patients in the field. The applicability of the study is severely limited by the difficulty of extracting the specific comparator agents and their doses from the report. Hence, substantial underdosing of iv analgesics in the field setting might account for much or all of the observed effect.

Physician rater

Very interesting article and useful information.

Physician rater

Interesting study on the efficacy in Spain of methoxyflurane compared with usual treatment. The study, however, was open label and was funded by Mundibioharma with all the bias associated with this design. Also, in the methoxyflurane group, 38 patients (24.4%) reported a total of 48 adverse events and in the standard analgesic treatment group, 8 patients (5.4%) reported a total of 9 adverse events. Furthermore, only 9.4% of patients were treated with opioids (8.1% intravenous). A blinded study is warranted before I add methoxyflurane to my analgesic tool kit.
Comments from PAIN+ CPN subscribers

Mr. Ian Tregunna (12/12/2019 8:41 PM)

A valuable tool if permitted in ambulances, fire trucks, and emergency wards.