Management of trauma pain in the emergency setting: low-dose methoxyflurane or nitrous oxide? A systematic review and indirect treatment comparison
Keith M Porter,1 Mohd Kashif Siddiqui,2 Ikksheta Sharma,2 Sara Dickerson,3 Alice Eberhardt4 1University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK; 2Parexel International Ltd, Chandigarh, India; 3Mundipharma International Ltd, Cambridge, UK; 4Mundipharma GmbH, Limburg, Germany Backgro...
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| Format: | Article |
| Language: | English |
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Dove Medical Press
2017-12-01
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| Series: | Journal of Pain Research |
| Subjects: | |
| Online Access: | https://www.dovepress.com/management-of-trauma-pain-in-the-emergency-setting-low-dose-methoxyflu-peer-reviewed-article-JPR |
| _version_ | 1828319287558799360 |
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| author | Porter KM Siddiqui MK Sharma I Dickerson S Eberhardt A |
| author_facet | Porter KM Siddiqui MK Sharma I Dickerson S Eberhardt A |
| author_sort | Porter KM |
| collection | DOAJ |
| description | Keith M Porter,1 Mohd Kashif Siddiqui,2 Ikksheta Sharma,2 Sara Dickerson,3 Alice Eberhardt4 1University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK; 2Parexel International Ltd, Chandigarh, India; 3Mundipharma International Ltd, Cambridge, UK; 4Mundipharma GmbH, Limburg, Germany Background: Low-dose methoxyflurane and nitrous oxide (N2O; 50:50 with oxygen) are both self-administered, self-titrated, rapid-acting, nonnarcotic, and noninvasive inhalational agents with similar onset times of pain relief. The aim of this review was to compare the clinical efficacy, safety, and tolerability of these analgesics in emergency care. Materials and methods: A systematic literature search and review according to Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines were performed using Embase, Medline, the Cochrane Library, several clinical trial registers, and emergency-medicine conference material. Results: Although both compounds have been used for many years in emergency care, the search found only a few controlled studies and no head-to-head trials performed in this setting. Two double-blind, randomized studies comparing their respective study medication (low-dose methoxyflurane or N2O) to placebo were identified that could be compared in an indirect approach by using placebo as a bridging comparator. Both agents provided rapid pain relief to trauma patients, with no significant differences between them; both treatments were generally well tolerated. Conclusion: Both low-dose methoxyflurane and N2O are suitable options for the pain treatment of trauma patients in the emergency setting. Due to the ease of administration and portability, inhaled low-dose methoxyflurane, however, may not only offer advantages in emergency situations in remote or difficult-to-reach locations and mass-casualty situations but also be of significant value in urban and rural environments. Keywords: methoxyflurane, nitrous oxide, trauma, pain treatment, emergency |
| first_indexed | 2024-04-13T17:54:18Z |
| format | Article |
| id | doaj.art-7a5e6ff1be9e44f3a40f5415ff5afe1d |
| institution | Directory Open Access Journal |
| issn | 1178-7090 |
| language | English |
| last_indexed | 2024-04-13T17:54:18Z |
| publishDate | 2017-12-01 |
| publisher | Dove Medical Press |
| record_format | Article |
| series | Journal of Pain Research |
| spelling | doaj.art-7a5e6ff1be9e44f3a40f5415ff5afe1d2022-12-22T02:36:34ZengDove Medical PressJournal of Pain Research1178-70902017-12-01Volume 11112136085Management of trauma pain in the emergency setting: low-dose methoxyflurane or nitrous oxide? A systematic review and indirect treatment comparisonPorter KMSiddiqui MKSharma IDickerson SEberhardt AKeith M Porter,1 Mohd Kashif Siddiqui,2 Ikksheta Sharma,2 Sara Dickerson,3 Alice Eberhardt4 1University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK; 2Parexel International Ltd, Chandigarh, India; 3Mundipharma International Ltd, Cambridge, UK; 4Mundipharma GmbH, Limburg, Germany Background: Low-dose methoxyflurane and nitrous oxide (N2O; 50:50 with oxygen) are both self-administered, self-titrated, rapid-acting, nonnarcotic, and noninvasive inhalational agents with similar onset times of pain relief. The aim of this review was to compare the clinical efficacy, safety, and tolerability of these analgesics in emergency care. Materials and methods: A systematic literature search and review according to Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines were performed using Embase, Medline, the Cochrane Library, several clinical trial registers, and emergency-medicine conference material. Results: Although both compounds have been used for many years in emergency care, the search found only a few controlled studies and no head-to-head trials performed in this setting. Two double-blind, randomized studies comparing their respective study medication (low-dose methoxyflurane or N2O) to placebo were identified that could be compared in an indirect approach by using placebo as a bridging comparator. Both agents provided rapid pain relief to trauma patients, with no significant differences between them; both treatments were generally well tolerated. Conclusion: Both low-dose methoxyflurane and N2O are suitable options for the pain treatment of trauma patients in the emergency setting. Due to the ease of administration and portability, inhaled low-dose methoxyflurane, however, may not only offer advantages in emergency situations in remote or difficult-to-reach locations and mass-casualty situations but also be of significant value in urban and rural environments. Keywords: methoxyflurane, nitrous oxide, trauma, pain treatment, emergencyhttps://www.dovepress.com/management-of-trauma-pain-in-the-emergency-setting-low-dose-methoxyflu-peer-reviewed-article-JPRMethoxyfluranenitrous oxidetraumapain treatmentemergency |
| spellingShingle | Porter KM Siddiqui MK Sharma I Dickerson S Eberhardt A Management of trauma pain in the emergency setting: low-dose methoxyflurane or nitrous oxide? A systematic review and indirect treatment comparison Journal of Pain Research Methoxyflurane nitrous oxide trauma pain treatment emergency |
| title | Management of trauma pain in the emergency setting: low-dose methoxyflurane or nitrous oxide? A systematic review and indirect treatment comparison |
| title_full | Management of trauma pain in the emergency setting: low-dose methoxyflurane or nitrous oxide? A systematic review and indirect treatment comparison |
| title_fullStr | Management of trauma pain in the emergency setting: low-dose methoxyflurane or nitrous oxide? A systematic review and indirect treatment comparison |
| title_full_unstemmed | Management of trauma pain in the emergency setting: low-dose methoxyflurane or nitrous oxide? A systematic review and indirect treatment comparison |
| title_short | Management of trauma pain in the emergency setting: low-dose methoxyflurane or nitrous oxide? A systematic review and indirect treatment comparison |
| title_sort | management of trauma pain in the emergency setting low dose methoxyflurane or nitrous oxide a systematic review and indirect treatment comparison |
| topic | Methoxyflurane nitrous oxide trauma pain treatment emergency |
| url | https://www.dovepress.com/management-of-trauma-pain-in-the-emergency-setting-low-dose-methoxyflu-peer-reviewed-article-JPR |
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