| INVITED REVIEW ARTICLE |
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| Year : 2023 | Volume
: 23
| Issue : 2 | Page : 65-74 |
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Clinical assessment and risk stratification for prehospital use of methoxyflurane versus standard analgesia in adult patients with trauma pain
Hany Zaki1, Süha Türkmen2, Aftab Azad1, Khalid Bashir3, Amr Elmoheen1, Eman Shaban4, Haris Iftikhar1, Nabil Shallik5
1 Department of Emergency Medicine, Hamad Medical Corporation, Doha, Qatar
2 Department of Emergency Medicine, Hamad Medical Corporation; College of Medicine, Qatar University, Doha, Qatar
3 Department of Clinical Academic, College of Medicine, Qatar University, Doha, Qatar
4 Al Jufairi Diagnosis and Treatment, Doha, Qatar
5 College of Medicine, Qatar University, Doha, Qatar
Correspondence Address:
Süha Türkmen
Department of Emergency Medicine, Hamad Medical Corporation, Doha
Qatar
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/tjem.tjem_229_22
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Oligoanalgesia, the undertreatment of trauma-related pain using standard analgesics in prehospital and emergency departments, has been extensively documented as one of the major challenges affecting the effective treatment of trauma-related pain. When administered in low doses, methoxyflurane has been highlighted by numerous medical works of literature to provide an effective, nonopioid, nonnarcotic treatment alternative to standard analgesics for prehospital and emergency department use. Low-dose methoxyflurane has been associated with fast-pain relief in adult patients manifesting moderate-to-severe pain symptoms. This systematic review and meta-analysis aimed to assess the clinical implication of low-dose methoxyflurane use in prehospital and emergency departments in adult patients with moderate-to-severe trauma-related pain. Moreover, the review aimed at assessing the risk stratification associated with using low-dose methoxyflurane in prehospital and emergency departments. The systematic review and meta-analysis performed a comprehensive search for pertinent literature assessing the implications and risks of using low-dose methoxyflurane in adult patients exhibiting moderate-to-severe trauma-related pain in prehospital settings. A comparison between the use of low-dose methoxyflurane and standard-of-care analgesics, placebo, in prehospital settings was reported in four clinically conducted randomized controlled trials (RCTs). These RCTs included the STOP! trial, InMEDIATE, MEDIATA, and the PenASAP trials. A meta-analysis comparing the time taken to achieve first pain relief on initial treatment of patients with moderate-to-severe trauma-related pain favored the use of low-dose methoxyflurane to the standard-of-care analgesics (mean difference = −6.63, 95% confidence interval = −7.37, −5.09) on time taken to establish effective pain relief. Low-dose methoxyflurane has been associated with superior and faster pain relief in prehospital and emergency departments in adult patients exhibiting moderate-to-severe trauma-related pain compared to other standard analgesics.
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