Evaluation of the efectiveness and costs of inhaled methoxyfurane versus usual analgesia for prehospital injury and trauma: non-randomised clinical study
Dublin Core
Title
Evaluation of the efectiveness and costs of inhaled methoxyfurane versus usual analgesia for prehospital injury and trauma: non-randomised clinical study
Subject
Prehospital, Emergency medical services, Analgesia, Pain, Ambulance, Methoxyfurane
Description
Background: We aimed to investigate clinical benefts and economic costs of inhaled methoxyfurane when used
by ambulance staf for prehospital emergency patients with trauma. Comparison is to usual analgesic practice (UAP)
in the UK in which patient records were selected if treatment had been with Entonox® or intravenous morphine or
intravenous paracetamol.
Methods: Over a 12-month evaluation period, verbal numerical pain scores (VNPS) were gathered from adults with
moderate to severe trauma pain attended by ambulance staf trained in administering and supplied with methoxyfurane. Control VNPS were obtained from ambulance database records of UAP in similar patients for the same period.
Statistical modelling enabled comparisons of methoxyfurane to UAP, where we employed an Ordered Probit panel
regression model for pain, linked by observational rules to VNPS.
Results: Overall, 96 trained paramedics and technicians from the East Midlands Ambulance Service NHS Trust
(EMAS) prepared 510 doses of methoxyfurane for administration to a total of 483 patients. Comparison data extracted
from the EMAS database of UAP episodes involved: 753 patients using Entonox®, 802 patients using intravenous
morphine, and 278 patients using intravenous paracetamol. Modelling results included demonstration of faster pain
relief with inhaled methoxyfurane (all p-values<0.001). Methoxyfurane’s time to achieve maximum pain relief was
estimated to be signifcantly shorter: 26.4 min (95%CI 25.0–27.8) versus Entonox® 44.4 min (95%CI 39.5–49.3); 26.5 min
(95%CI 25.0–27.9) versus intravenous morphine 41.8 min (95%CI 38.9–44.7); 26.5 min (95%CI 25.1–28.0) versus
intravenous paracetamol 40.8 (95%CI 34.7–46.9). Scenario analyses showed that durations spent in severe pain were
signifcantly less for methoxyfurane. Costing scenarios showed the added benefts of methoxyfurane were achieved
at higher cost, eg versus Entonox® the additional cost per treated patient was estimated to be £12.30.
Conclusion: When administered to adults with moderate or severe pain due to trauma inhaled methoxyfurane
reduced pain more rapidly and to a greater extent than Entonox® and parenteral analgesics. Inclusion of inhaled
methoxyfurane to the suite of prehospital analgesics provides a clinically useful addition, but one that is costlier per
treated patient.
by ambulance staf for prehospital emergency patients with trauma. Comparison is to usual analgesic practice (UAP)
in the UK in which patient records were selected if treatment had been with Entonox® or intravenous morphine or
intravenous paracetamol.
Methods: Over a 12-month evaluation period, verbal numerical pain scores (VNPS) were gathered from adults with
moderate to severe trauma pain attended by ambulance staf trained in administering and supplied with methoxyfurane. Control VNPS were obtained from ambulance database records of UAP in similar patients for the same period.
Statistical modelling enabled comparisons of methoxyfurane to UAP, where we employed an Ordered Probit panel
regression model for pain, linked by observational rules to VNPS.
Results: Overall, 96 trained paramedics and technicians from the East Midlands Ambulance Service NHS Trust
(EMAS) prepared 510 doses of methoxyfurane for administration to a total of 483 patients. Comparison data extracted
from the EMAS database of UAP episodes involved: 753 patients using Entonox®, 802 patients using intravenous
morphine, and 278 patients using intravenous paracetamol. Modelling results included demonstration of faster pain
relief with inhaled methoxyfurane (all p-values<0.001). Methoxyfurane’s time to achieve maximum pain relief was
estimated to be signifcantly shorter: 26.4 min (95%CI 25.0–27.8) versus Entonox® 44.4 min (95%CI 39.5–49.3); 26.5 min
(95%CI 25.0–27.9) versus intravenous morphine 41.8 min (95%CI 38.9–44.7); 26.5 min (95%CI 25.1–28.0) versus
intravenous paracetamol 40.8 (95%CI 34.7–46.9). Scenario analyses showed that durations spent in severe pain were
signifcantly less for methoxyfurane. Costing scenarios showed the added benefts of methoxyfurane were achieved
at higher cost, eg versus Entonox® the additional cost per treated patient was estimated to be £12.30.
Conclusion: When administered to adults with moderate or severe pain due to trauma inhaled methoxyfurane
reduced pain more rapidly and to a greater extent than Entonox® and parenteral analgesics. Inclusion of inhaled
methoxyfurane to the suite of prehospital analgesics provides a clinically useful addition, but one that is costlier per
treated patient.
Creator
Murray D. Smith , Elise Rowan, Robert Spaight and Aloysius N. Siriwardena
Publisher
BMC Emergency Medicine
Date
(2022) 22:122
Contributor
Fajar Bagus W
Format
PDF
Language
English
Type
Text
Files
Collection
Citation
Murray D. Smith , Elise Rowan, Robert Spaight and Aloysius N. Siriwardena, “Evaluation of the efectiveness and costs of inhaled methoxyfurane versus usual analgesia for prehospital injury and trauma: non-randomised clinical study,” Repository Horizon University Indonesia, accessed November 21, 2024, https://repository.horizon.ac.id/items/show/4131.