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Methoxyflurane as an analgesic and sedative agent in oral and maxillofacial surgery: a scoping review

Bernardo Correia Lima1, Pedro Américo Felizardo Dos Santos2, Michelle Alonso Coutinho3

  • 1Department of Oral and Maxillofacial Surgery, Traumatology and Prosthesis, Dental School of University of São Paulo, São Paulo SP, Brazil.

Journal of Stomatology, Oral and Maxillofacial Surgery
|July 20, 2026
PubMed
Abstract

Insights

Low-dose methoxyflurane (MOF) shows promise for oral and maxillofacial surgery (OMFS), offering effective pain relief and sedation. Further high-quality trials are needed to confirm its role in OMFS procedures and acute oral pain management.

Area of Science:

  • Anesthesiology
  • Oral and Maxillofacial Surgery
  • Pain Management

Background:

  • Methoxyflurane (MOF) is a low-dose inhaled analgesic with rapid onset and patient-controlled titration.
  • Its safety profile at sub-anesthetic doses is established, but its application in oral and maxillofacial surgery (OMFS) requires comprehensive mapping.
  • Current evidence on MOF in OMFS is limited, necessitating a review of available data.

Purpose of the Study:

  • To map and characterize existing evidence on the use of inhaled methoxyflurane in OMFS.
  • To evaluate MOF's efficacy in dento-alveolar surgery, acute oral pain emergencies, and outpatient analgesic-sedation.
  • To identify gaps in the literature and guide future research directions.

Main Methods:

  • A scoping review was conducted following JBI methodology and reported per PRISMA-ScR guidelines.
  • Eligibility criteria were defined using the PCC (Population, Concept, Context) framework.
  • Extensive literature searches were performed across multiple databases (MEDLINE, Embase, Cochrane CENTRAL, Scopus, Web of Science) without date restrictions.

Main Results:

  • Twenty studies were identified, with 10 directly relevant to OMFS/dental applications.
  • MOF demonstrated comparable sedation and superior patient preference over nitrous oxide in third molar surgery (p<0.05).
  • Systematic reviews indicated high patient satisfaction (63%-98%) and no serious adverse events in outpatient settings at analgesic doses.

Conclusions:

  • Evidence supports the clinical feasibility of MOF in OMFS, particularly for third molar surgery and acute oral pain.
  • High-quality, OMFS-specific randomized controlled trials (RCTs) are currently lacking.
  • The ongoing METODO trial (NCT06495372) is expected to provide pivotal data, with future research needed on OMFS-specific protocols and regulatory approvals.
Keywords:
Conscious sedationDento-alveolar surgeryInhaled analgesicsMethoxyfluraneOral and maxillofacial surgeryPenthroxProcedural analgesiaScoping review

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