Dr Murray Smith, senior research fellow in econometrics and health economics, gave an oral presentation of CaHRU’s study on ‘Clinical effectiveness and costs of prehospital inhaled methoxyflurane for acute pain in trauma in adults‘ at the 999 EMS Research Forum Conference 2021. The conference ‘Research in prehospital care: Past, pandemic, present & future’ took place online on Tuesday 23 March 2021. The study team included Dr Smith who led the analysis, with Dr Elise Rowan of CaHRU, Rob Spaight of East Midlands Ambulance Service NHS Trust (EMAS) and Prof Niro Siriwardena, director of CaHRU.
Methoxyflurane (Penthrox®; Galen Ltd), which has been used in practice as an inhalational analgesic based on hospital studies, was more recently issued a European licence for emergency relief of moderate to severe pain in conscious adults with trauma pain. The presentation described the implementation and evaluation of methoxyflurane in the prehospital setting using statistical/econometric modelling to show the effect of methoxyflurane compared with usual analgesics such as Entonox, intravenous paracetamol or intravenous morphine taking into account patient age, sex, clinical condition, and initial pain score.
The study involved training 96 EMAS paramedics and Emergency Medical Technicians (EMTs) who administered methoxyflurane over one year from 2018 to 2019 for adults with trauma, in place of or in addition to usual analgesics. Methoxyflurane reduced pain from severe (pain score 7-10) to moderate (pain score 4-6) levels within 10 minutes, which was more than three times more quickly than Entonox or intravenous paracetamol and more than twice as quickly as intravenous morphine. Both paramedics and EMTs were able to use methoxyflurane and this was a benefit for patients because EMTs are not able to give intravenous paracetmol or morphine. Clinician reported adverse effects minor and infrequent and benefits were achieved at a modestly greater cost. Study limitations related to observational data and methods. This study, the largest prehospital study of methoxyflurane, was conducted independently from the funder, Galen Ltd. To see the presentation click here.