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Pain Self-Management with Inhaled Methoxyflurane by Emergency Department Trauma Patients: A Prospective,
Daniel Aiham Ghazali1,2,3, Donia Bouzid3,4, Alix Frachon4
1Emergency Department and Emergency Medical Services, Amiens University Medical Center, 1 Rond-Point du Professeur Christian Cabrol, 80000 Amiens, France.
Summary
Self-administered methoxyflurane combined with the World Health Organization (WHO) analgesic ladder effectively reduced trauma pain in emergency departments. This approach led to a greater decrease in pain scores and fewer patients experiencing pain upon discharge.
Area of Science:
- Emergency Medicine
- Pain Management
- Pharmacology
Background:
- The COVID-19 pandemic caused emergency department (ED) overcrowding, impacting patient care.
- Lower-acuity non-COVID-19 patients in a pre-ED fast-track zone require effective pain management.
- Standard analgesic ladders may need adjunctive therapies for optimal pain relief.
Purpose of the Study:
- To evaluate the efficacy of self-administered, inhaled, low-dose methoxyflurane as an adjunct to the WHO analgesic ladder for trauma pain.
- To assess the impact of methoxyflurane on pain reduction in a pre-ED setting.
- To compare pain scores and discharge pain levels between standard care and methoxyflurane intervention.
Main Methods:
- A prospective, interventional, single-center study at Bichat University Medical Center, Paris, France.
- Two groups: control (standard WHO analgesic ladder) and intervention (methoxyflurane adjunct to WHO ladder).
- Primary endpoint: Numerical Pain Rating Scale (NPRS) scores at various time points; secondary: agreement with WHO ladder (Cohen's kappa).
Main Results:
- High agreement between NPRS and WHO analgesic ladder in both groups (Cohen's kappa: 0.74 control, 0.70 intervention).
- Significant NPRS score decrease from arrival to discharge in both groups (p < 0.001).
- Greater NPRS reduction between triage and discharge in the methoxyflurane group (p < 0.001); significantly fewer patients in pain at discharge (p = 0.001).
Conclusions:
- Self-administered methoxyflurane improves pain management in the ED when used with the WHO analgesic ladder.
- Methoxyflurane offers an effective adjunctive therapy for mild-to-moderate trauma pain in a pre-ED setting.
- This strategy can reduce patient-reported pain and improve outcomes in overcrowded emergency departments.
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