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MethOxyfluraNe in InTerventiOnal Radiology (MONITOR): A randomised controlled trial
Ross Copping1,2, Paul Balamon1, Marcus Lau1
1Interventional Radiology Department, Liverpool Hospital, Sydney, New South Wales, Australia.
Introduction:
Procedural sedation and pain management in interventional radiology (IR) are of critical importance to successful outcomes but remain under-researched. Methoxyflurane has been previously used in some minor procedures with several advantages including rapid onset and offset and a good safety profile. The purpose of this study was to evaluate methoxyflurane for procedures in IR.
Methods:
A randomised, double-blind, placebo-controlled trial was performed between October 2021 and November 2022. Patients presenting for portacath insertion, portacath removal or solid organ biopsy were randomised to either methoxyflurane or placebo. Three hundred and fourteen patients were enrolled in total. Patients were supplied with one Penthrox inhaler containing either 3 mL methoxyflurane or placebo. The primary endpoints of the study were change in pain and anxiety scores compared with baseline, measured on a standardised visual analogue scale (VAS) pre-procedure, at 5-min intervals during the procedure and post-procedure. Baselines scores were controlled for in the statistical analysis. Safety analysis was also performed.
Results:
One hundred and sixty-nine patients received methoxyflurane and 145 received placebo. Baseline characteristics were similar between the two groups. The methoxyflurane group had lower pain and anxiety scores throughout the procedure (P < 0.001) with 2.5 times less pain (VAS 1.08/10) and 1.6 times less anxiety (VAS 0.97/10) on average. Lower post-procedure pain (mean 0.72 vs 1.44; P < 0.001) and anxiety (mean 0.55 vs 1.13; P = 0.008) were also observed with methoxyflurane. There were no drug or major procedure-related adverse events.
Conclusion:
The results of this study suggest that methoxyflurane provides safe and effective analgesia and anxiolysis for some procedures in IR.
Insights
Methoxyflurane effectively reduced pain and anxiety during interventional radiology (IR) procedures. This study found methoxyflurane to be a safe and beneficial option for analgesia and anxiolysis in IR.
Area of Science:
- Medical research
- Anesthesiology
- Interventional Radiology
Background:
- Procedural sedation and pain management are crucial in interventional radiology (IR) but are under-researched.
- Methoxyflurane, known for rapid onset/offset and a good safety profile, has been used in minor procedures.
Purpose of the Study:
- To evaluate the efficacy and safety of methoxyflurane for sedation and pain management in interventional radiology (IR) procedures.
Main Methods:
- A randomized, double-blind, placebo-controlled trial involving 314 patients undergoing portacath insertion/removal or solid organ biopsy.
- Patients received either methoxyflurane or placebo via a Penthrox inhaler.
- Pain and anxiety scores (Visual Analogue Scale) were measured pre-procedure, during, and post-procedure.
Main Results:
- The methoxyflurane group experienced significantly lower pain and anxiety scores throughout the procedure compared to placebo (P < 0.001).
- Methoxyflurane resulted in 2.5 times less pain and 1.6 times less anxiety on average during procedures.
- No major drug or procedure-related adverse events were reported in the methoxyflurane group.
Conclusions:
- Methoxyflurane demonstrates safety and effectiveness in providing analgesia and anxiolysis for select interventional radiology procedures.
- The findings support methoxyflurane as a valuable option for pain and anxiety management in IR.
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