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Management of trauma pain in the emergency setting: low-dose methoxyflurane or nitrous oxide? A systematic review and indirect treatment comparison

Authors Porter KM, Siddiqui MK, Sharma I, Dickerson S, Eberhardt A

Received 1 September 2017

Accepted for publication 12 October 2017

Published 20 December 2017 Volume 2018:11 Pages 11—21


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Dr Michael Schatman

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.
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

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