Inhaled Methoxyflurane Provides Greater Analgesia and Faster Onset of Action Versus Standard Analgesia in Patients With Trauma Pain: InMEDIATE: A Randomized Controlled Trial in Emergency Departments

• Published in: Annals of emergency medicine 2020-03, Vol.75 (3), p.315-328
• Main Authors: Borobia, Alberto M., Collado, Sergio García, Cardona, César Carballo, Pueyo, Rosa Capilla, Alonso, Cesáreo Fernández, Torres, Ignacio Pérez, González, María Corell, Casal Codesido, José Ramón, Betegón, María Arranz, Barcela, Luis Amador, Andicoechea, Aitor Odiaga, Testa, Anselma Fernández, Colina, Jorge Trigo, Dorribo, Antonio Cid, del Arco Galán, Carmen, Martínez Ávila, Jose Carlos, Lugilde, Susana Traseira, Carcas Sansuán, Antonio J., Marisca, Claudio Bueno, Rodríguez, Pedro Mesa, Romero, Emilio Montero, González, José Lázaro, Jañez Álvarez, María A., Alonso, Roberto Rodríguez, Nos, Javier del Castillo, Duran Ruiz, Manuel V., Soriano, Pere Llorens, Poy, Wilkins, Santos, Luis Sanchez, del Caño, Fátima Barcala, García, Ángela Dopico, Gaviño, Paula Núñez, Fernández Linares, Elena Sánchez, Cruz, Jose Valle, Sanz Cadenas, Norma B., Aragonés, Maite Ayuso, Dani, Lubna, Peña, Olga González, Jaén Cañadas, María M., Briñas, Mikel Rico, Cheng, Yale Tung, Isidro, Isabel López, Armengou, Laura Ferrer, Ávila, Paula Molina, Etxebarria Gulías, Amaia, Lombardía, Kristina García, Brüggenmann, Patricia Wunderling
• Format: Article
• Language: English
• Subjects: Acute Pain - drug therapy; Administration, Inhalation; Aged; Analgesia - methods; Analgesics - therapeutic use; Anesthetics, Inhalation - administration & dosage; Anesthetics, Inhalation - therapeutic use; Emergency Service, Hospital; Female; Humans; Male; Methoxyflurane - administration & dosage; Methoxyflurane - therapeutic use; Middle Aged; Pain Management - methods; Pain Measurement; Wounds and Injuries - therapy
• ISSN: 0196-0644; 1097-6760
• DOI: 10.1016/j.annemergmed.2019.07.028

The objective of the InMEDIATE study was to evaluate the change in intensity of traumatic pain over the first 20 min in adult patients treated with methoxyflurane versus standard analgesic treatment in Spain. This the first randomized, active-controlled, multicenter trial of methoxyflurane in the emergency setting in Europe. This was a randomized, controlled study that enrolled adult patients with acute moderate to severe (score ≥4 on the 11-point Numeric Rating Scale) trauma-associated pain in 14 Spanish emergency departments. Patients were randomized 1:1 to methoxyflurane (up to 2×3 mL) or standard analgesic treatment. Coprimary endpoints were the change from baseline in Numeric Rating Scale pain intensity score during the first 20 minutes of treatment and time to first pain relief. Three hundred five patients were randomized (methoxyflurane 156; standard analgesic treatment 149). Most patients in the standard analgesic treatment group (70%) received intravenous first-step analgesics and 9.4% of patients were treated with opioids. Mean decrease from baseline in Numeric Rating Scale pain intensity score was greater for methoxyflurane than standard analgesic treatment at all points, with a significant treatment difference overall up to 20 minutes (repeated-measures model 2.47 versus 1.39; treatment difference 1.00; 95% confidence interval 0.84 to 1.32). Median time to first pain relief was significantly shorter for methoxyflurane than standard analgesic treatment (3 versus 10 minutes). Methoxyflurane achieved better patient and clinician ratings for pain control and comfort of treatment than standard analgesic treatment and exceeded patient and clinician expectations of treatment in, respectively, 77% and 72% of cases compared with 38% and 19% for standard analgesic treatment. These results support consideration of methoxyflurane as a nonnarcotic, easy-to-administer, rapid-acting, first-line alternative to currently available analgesic treatments for trauma pain.