A Pilot Study on the Use of Methoxyflurane (Penthrox®) for Pain Control in the Emergency Department

Launched by HOSPITAL AUTHORITY, HONG KONG · Oct 31, 2020

Keywords

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Gender

ALL

Eligibility criteria

• Inclusion Criteria:
• • Patients of both sexes from 18 to 64 years of age
• • Presented to the ED in Ruttonjee Hospital for musculoskeletal injury within 72 hours of onset (Types of injury include contusion, sprain, crushing, burn, laceration, fracture and dislocation)
• • Moderate pain at screening (10-point Numeric Rating Scale ≥4 to ≤7)
• Exclusion Criteria:
• • Critical or life-threatening condition requiring resuscitation
• • Limb-threatening condition or any injuries requiring immediate management
• • Hemodynamically unstable (systolic blood pressure \<90 mmHg, diastolic blood pressure \<60mmHg)
• • Respiratory distress with respiratory rate \>20 breath per minute or oxygen saturation \<95% on room air
• • Pregnant or breastfeeding women
• • Impaired consciousness from any cause such as head injury and acute intoxication, based on the judgement of investigator
• • Any physical, visual or cognitive conditions that may affect patient's ability to use visual analog scale for self-assessments of pain intensity
• • Concomitant use of other analgesic within 5 hours (8 hours for diclofenac sodium) prior to presentation to ED
• • Other pre-existing chronic pain condition
• • Unable or refuse to provide written informed consent
• • Unable to understand and converse in the language spoken
• • Contraindication to inhalational methoxyflurane
• • 1. Known personal or family history of hypersensitivity to methoxyflurane or any fluorinated anesthetics
• • 2. Known pre-existing clinically significant renal or hepatic impairment
• • 3. Known personal or family history of malignant hyperthermia
• • 4. Concomitant use of nephrotoxic agents such as gentamicin, tetracycline, colistin, polymyxin B and amphotericin B
• • 5. Concomitant use of cytochrome P450 inducers such as alcohol, isoniazid, phenobarbital and rifampicin
• • Contraindication to intramuscular ketorolac
• • 1. Known allergy to NSAIDS
• • 2. Known pre-existing clinically significant renal impairment or at risk for renal failure due to volume depletion
• • 3. Active major bleeding
• • 4. Suspected or confirmed cerebrovascular bleeding
• • 5. History of peptic ulcer disease, gastrointestinal bleeding or perforation
• • 6. Concomitant use of aspirin, other NSAIDS, anticoagulant or novel anticoagulant agent, pentoxifylline and probenecid
• • 7. Known bleeding disorders such as haemophilia, thrombocytopenia
• • 8. Heart failure
• • 9. Per-operative period of coronary artery bypass graft (CABG) surgery
• • 10. Concurrent asthmatic attack