PENTHROX™ - MethoxyfluraneHistory and Experience in the Management
of Pain
Clinical Need
Inherent need to offer patients analgesia for existing or potential pain
Current options:• Local anaesthetics, oral analgesics, narcotics
and …
Clinical Need
Current analgesic options may be less than ideal due to:
• Limited efficacy• Inconvenient administration• Length of onset or duration of action• Adverse reactions (e.g., respiratory depression)
Methoxyflurane
• Originally a general anaesthetic agent • Now Contraindicated due to safety concerns with dose
• Unique in producing powerful analgesic properties at very low sub-anaesthetic concentrations
• Currently indicated for trauma and minor surgical procedures
• Needs NO pre-medication
or fasting
Features of Methoxyflurane
• Potent analgesic with rapid onset
(6 – 10 breaths)
• Demonstrated cardiovascular and
respiratory stability
• No significant adverse effects
• Can be administered easily to patients
of virtually all ages
Penthrox™ Inhaler
The Penthrox™ Inhaler is a tubular light-weight disposable inhaler device that features:
• Internal wick (absorption matrix)• Dilutor hole enables two concentrations• One-way valve to prevent blow-back• 22mm mouthpiece – connects to face
mask
Penthrox given intermittently
0
20
40
60
80
100
1 4 7 10 13 16 19 22 25 28
Possibly Minutes
% 0
f ana
lges
ic s
erum
leve
l
6 breaths 6 breaths 6 breaths
Intermittent Usage of Methoxyflurane
• Use intermittently as needed, or just before planned possible painful stage during intervention
• Best to empower the patient to self-administer intermittently
• Gentle assistance/direction as needed
• Patient may close eyes as they relax, rarely drowsy – easily roused
• Recovery is quick
Assisting the Patient to Manage Pain
Clinical Studies
The analgesic safety and efficacy of methoxyflurane has been evaluated in a variety of areas:
• Pre-hospital• Emergency• Burns• Dental• Obstetrics• Aesthetic surgery
Case Series (Buntine, 2007)
• 83 adult patients receiving paramedical assistance and transport to urban teaching hospital
• Age range = 17 to 95 years
• Methoxyflurane administered via Penthrox™ Inhaler
• Administration duration = median of 29 minutes
• Indication included musculoskeletal injury, visceral pain and back pain
Case Series (Buntine): ResultsStatistically significant reduction in pain scores compared with baseline (p < 0.0001)
Case Series (Babl, 2006):
• 105 paediatric patients receiving paramedical assistance and transport to tertiary children’s hospital
• Age range = 15 months to 17 years
• Methoxyflurane administered via Penthrox Inhaler
• Administration duration = median of 20 minutes
• No pre-medications, no food or fluid restrictions
Case Series (Babl): Results• Methoxyflurane administration resulted in a 43.0%
reduction in pain scores within 10 minutes
• 88.5% of paramedics were satisfied to very satisfied with the level of patient analgesia
• 87.0% of patients were satisfied to very satisfied with the level of analgesia
• 96.9% of primary care providers and older patients would want to use Methoxyflurane again for pain control
Clinical Poster (Wilkes and Oxer, 2007):
• 17,344 patients receiving paramedical assistance and transport to hospital
• Age range = 2 years to 95+ years
• Methoxyflurane administered via Penthrox Inhaler = 13,313 patients
• Fentanyl administered intra-nasally = 4,021 patients
• No pre-medications, no food or fluid restrictions
Clinical Poster (Wilkes and Oxer): Results
• No significant side effects reported
• Methoxyflurane particularly useful in children
• Analgesia from methoxyflurane found to be equivalent to intra-nasal fentanyl
Good / excellent relief
Partial relief No relief
Methoxyflurane 54.3% 38.4% 7.3%
Intra-nasal fentanyl
52.9% 39.8% 7.4%
Examples of Use – Ambulance and Rescue• Physical trauma
• Domestic trauma
• Motor vehicle accidents
• Pain / injury
• Mass casualty
• Emergency rescue
Hospital
• Accident and emergency
• Minor surgical procedures
• Burns / wound management
• Radiology
• Oncology
• Acute pain services
First Response
• Worksite injuries
• Sporting injuries
• Injuries at mass public
gatherings
• Physical trauma
• Mass Trauma
• Remote Areas
Methoxyflurane Use – Severe Burns
• Patient with severe burns and excruciating pain – immersed in water to cool
• Immediate relief from suffering
• watch patient’s face
• Clinical team can immediately treat patient
Potential PopulationPatients who may benefit include those:
• In pain
• Anxious
• Pain intolerant
• Dislike of needles or injections
• Uncooperative
• Preparing for a painful
procedure
Summary
Methoxyflurane has been clinically
demonstrated over many years to be a
safe and effective agent offering patients
comfort and relief from pain
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