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A pilot study of inhaled methoxyflurane for procedural analgesia in children
Franz Babl1, Peter Barnett, Greta Palmer
1Department of Emergency Medicine, Royal Children's Hospital and Murdoch Childrens Research Institute, Melbourne, Australia. franz.babl@rch.org.au
Background:
Methoxyflurane (MF), a potent volatile anesthetic, can be used as an analgesic in subanesthetic concentrations. In Australia, MF is extensively used in children and adults as an analgesic in the prehospital setting via a hand-held inhaler device. We conducted a pilot study to explore its use as a patient controlled analgesic for painful procedures in children in the emergency department (ED).
Methods:
This is a prospective observational case series of children aged 5 years and older requiring procedural analgesia for brief painful procedures. Pain scores, depth of sedation, adverse events and patient, parent and staff satisfaction were assessed as well as consumption of MF measured.
Results:
Fourteen patients (aged 6-13 years) received MF mainly for extremity injuries. Amount of MF consumed ranged from 0.36 to 3.06 g per patient inhaled over 4-25 min. There were no serious adverse events. No patient was deeply sedated. Five patients had mild brief self-resolving adverse events including agitation, euphoria, blurry vision, dizziness and cough. Four patients with fractures with initial high pain scores (> or =6) received MF for bridging analgesia with large drops in pain scores. Four patients who required fracture reductions with initial low scores did not achieve adequate analgesia. The remaining six patients had painful procedures undertaken with satisfactory analgesia.
Conclusions:
On the basis of this small pilot study of MF use in children in the ED, this agent appears to be a powerful analgesic. MF seems most useful as a self-titrated bridging analgesic agent in patients after extremity trauma. It appears less useful as a procedural agent when patients are unable to anticipate and achieve a sufficient level of analgesia before painful stimulus infliction. Pre- and intraprocedure coaching is an important aspect of its use especially if initial pain scores are low.
Insights
Methoxyflurane (MF) shows promise as a self-administered analgesic for children in the emergency department, particularly for extremity trauma. While effective for bridging pain relief, its utility as a sole procedural agent is limited without proper patient coaching.
Area of Science:
- Emergency Medicine
- Pediatric Anesthesiology
- Pain Management
Background:
- Methoxyflurane (MF) is a volatile anesthetic used for analgesia in subanesthetic concentrations.
- It is widely used in Australia for prehospital pain relief in children and adults.
- A pilot study explored MF's potential as a patient-controlled analgesic in pediatric emergency departments.
Purpose of the Study:
- To investigate the efficacy and safety of methoxyflurane (MF) as a patient-controlled analgesic for children undergoing painful procedures in the emergency department (ED).
- To assess pain scores, sedation levels, adverse events, and satisfaction with MF use.
Main Methods:
- Prospective observational case series involving children aged 5 years and older requiring procedural analgesia.
- Data collected included pain scores, sedation depth, adverse events, patient/parent/staff satisfaction, and MF consumption.
- Methoxyflurane administered via a hand-held inhaler device.
Main Results:
- Fourteen children (6-13 years) received MF, primarily for extremity injuries.
- MF consumption varied (0.36-3.06 g over 4-25 min) with no serious adverse events; sedation was minimal.
- Effective bridging analgesia was observed for high-pain fracture cases, but less so for fracture reductions when pain was initially low. Satisfactory analgesia was achieved in six patients.
Conclusions:
- Methoxyflurane (MF) demonstrates significant analgesic potential in pediatric emergency settings, especially as a self-titrated bridging agent for extremity trauma.
- Its effectiveness as a procedural agent is limited when patients cannot self-administer adequate analgesia prior to painful stimuli.
- Patient coaching before and during procedures is crucial for optimal MF use, particularly in cases with initially low pain scores.
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