Agnès Ricard-Hibon1, Nathalie Lecoules2, Dominique Savary3, Laurent Jacquin4, Eric Wiel5, Patrick Deschamps1, Marion Douplat6, François Montestruc7, Bérangère Chomier8, Karim Tazarourte4, Frédéric Adnet9. 1. Emergency Department SAMU-SMUR 95, CHG Pontoise-Beaumont/Oise Pontoise. 2. Emergency Department, CHU Purpan, Toulouse. 3. Emergency Department, Centre Hospitalier Annecy Genevois, Annecy. 4. Emergency Department, Hôpital Edouard Herriot, Hospices Civils de Lyon, University Lyon 1 EA 425, Lyon. 5. Emergency Department-SAMU du Nord, CHU Lille, Lille. 6. Emergency Department, Hôpital Lyon Sud Hospices Civils de Lyon, Lyon. 7. Biometry, eXYSTAT SAS, Malakoff. 8. Medical affairs, Mundipharma SAS, Paris. 9. Emergency Department SAMU 93 Inserm U942, AP-HP Hôpital Avicenne l, Bobigny, France.
Abstract
BACKGROUND: Oligo-analgesia is common in the emergency department (ED). This study aimed at reporting, when initiated by triage nurse, the superior efficacy of inhaled methoxyflurane plus standard of care (m-SoC) analgesia versus placebo plus SoC (p-SoC) for moderate-to-severe trauma-related pain in the hospital ED. METHODS: A randomised, double-blind, placebo-controlled trial was conducted at eight EDs. Adults with pain score ≥4 (11-point numerical rate scale, NRS) at admission were randomised to receive one or two inhalers containing m-SoC or p-SoC. Primary outcome measure was time until pain relief ≤30 mm, assessed on the 100-mm Visual Analogic Scale (VAS). RESULTS:A total of 351 patients were analysed (178 m-SoC; 173 p-SoC). Median pain prior to first inhalation was 66 mm, 75% had severe pain (NRS 6-10). Median time to pain relief was 35 min [95% confidence interval (CI), 28-62] for m-SoC versus not reached in p-SoC (92 - not reached) [hazard ratio), 1.93 (1.43-2.60), P < 0.001]. Pain relief was most pronounced in the severe pain subgroup: hazard ratio, 2.5 (1.7-3.7). As SoC, 24 (7%) patients received weak opioids (6 versus 8%), 4 (1%) strong opioid and 44 (13%) escalated to weak or strong opioids (8 versus 17%, respectively, P = 0.02). Most adverse events were of mild (111/147) intensity. CONCLUSIONS: In this study, we report that methoxyflurane, initiated at triage nurse as part of a multimodal analgesic approach, is effective in achieving pain relief for trauma patients. This effect was particularly pronounced in the severe pain subgroup.
RCT Entities:
BACKGROUND: Oligo-analgesia is common in the emergency department (ED). This study aimed at reporting, when initiated by triage nurse, the superior efficacy of inhaled methoxyflurane plus standard of care (m-SoC) analgesia versus placebo plus SoC (p-SoC) for moderate-to-severe trauma-related pain in the hospital ED. METHODS: A randomised, double-blind, placebo-controlled trial was conducted at eight EDs. Adults with pain score ≥4 (11-point numerical rate scale, NRS) at admission were randomised to receive one or two inhalers containing m-SoC or p-SoC. Primary outcome measure was time until pain relief ≤30 mm, assessed on the 100-mm Visual Analogic Scale (VAS). RESULTS: A total of 351 patients were analysed (178 m-SoC; 173 p-SoC). Median pain prior to first inhalation was 66 mm, 75% had severe pain (NRS 6-10). Median time to pain relief was 35 min [95% confidence interval (CI), 28-62] for m-SoC versus not reached in p-SoC (92 - not reached) [hazard ratio), 1.93 (1.43-2.60), P < 0.001]. Pain relief was most pronounced in the severe pain subgroup: hazard ratio, 2.5 (1.7-3.7). As SoC, 24 (7%) patients received weak opioids (6 versus 8%), 4 (1%) strong opioid and 44 (13%) escalated to weak or strong opioids (8 versus 17%, respectively, P = 0.02). Most adverse events were of mild (111/147) intensity. CONCLUSIONS: In this study, we report that methoxyflurane, initiated at triage nurse as part of a multimodal analgesic approach, is effective in achieving pain relief for traumapatients. This effect was particularly pronounced in the severe pain subgroup.
Authors: Andrea Fabbri; Germana Ruggiano; Sergio Garcia Collado; Agnes Ricard-Hibon; Umberto Restelli; Giovanni Sbrana; Franco Marinangeli; Alberto Farina; Frank Coffey Journal: J Pain Res Date: 2020-06-25 Impact factor: 3.133
Authors: Andrea Fabbri; Alberto M Borobia; Agnes Ricard-Hibon; Frank Coffey; Aurore Caumont-Prim; François Montestruc; Amedeo Soldi; Susana Traseira Lugilde; Sara Dickerson Journal: J Pain Res Date: 2021-01-20 Impact factor: 3.133
Authors: Helmut Trimmel; Alexander Egger; Reinhard Doppler; Christoph Beywinkler; Wolfgang G Voelckel; Janett Kreutziger Journal: Anaesthesist Date: 2021-10-18 Impact factor: 1.041