Evidence map›Paper›PMID 39174051›Full record

Trial reportRegional anesthesia and pain medicine2025

Analgesic effectiveness of methoxyflurane inhaler during genicular nerve block in knee osteoarthritis: a randomized controlled trial.

Saowanee Sawang, Pretimon Kimpee, Wichai Itthichaikulthol, Nuj Tontisirin, Suwimon Limpoon, Rattaphol Seangrung, Koravee Pasutharnchat, Steven Paul Cohen

Abstract readRandomized Controlled Trial
In one paragraph

Trial report in Regional anesthesia and pain medicine, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Guideline
  2. Article
  3. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors.

Saowanee SawangDepartment of Anesthesiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.ORCID 0000-0003-3743-7436
Pretimon KimpeeChakri Naruebodindra Medical Institute (CNMI), Mahidol University, Bang Phli, Samut Prakan, Thailand.ORCID 0009-0004-2362-098X
Wichai ItthichaikultholDepartment of Anesthesiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.ORCID 0000-0002-8288-3876
Nuj TontisirinDepartment of Anesthesiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand doctornuj@gmail.com.ORCID 0000-0002-5938-8893
Suwimon LimpoonDepartment of Anesthesiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.ORCID 0009-0002-5456-3848
Rattaphol SeangrungDepartment of Anesthesiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.ORCID 0000-0002-6805-7295
Koravee PasutharnchatDepartment of Anesthesiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.ORCID 0000-0001-8578-9247
Steven Paul CohenDepartment of Anesthesiology, Physical Medicine & Rehabilitation, Neurology, Psychiatry and Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.ORCID 0000-0001-5928-2127

Funding

Effects of Sleep Disruption on Subjective Responses to Opioid Administration in Patients with Chronic PainR01DA048206 · NIDA · JOHNS HOPKINS UNIVERSITY · PI FINAN, PATRICK, SMITH, MICHAEL T · 2019 to 2024
$4.8M
University of Pittsburgh Hub and Spoke Pain Clinical Trial NetworkU24NS115708 · NINDS · UNIVERSITY OF PITTSBURGH AT PITTSBURGH · PI ALTER, BENEDICT J, WASAN, AJAY D · 2019 to 2024
$1.2M
NHGRI NIH HHS GR101558NIDA NIH HHS R01 DA048206NINDS NIH HHS U24 NS115708Uniformed Services University 1UH3135804US Department of Defense HU0001- 15- 2- 0003
6 · The paper itself

Abstract

backgroundUp to 30% of patients with knee osteoarthritis (KOA) have evidence of sensitization, with a similar proportion experiencing severe pain during procedures. Most patients with KOA are elderly and often develop side effects from intravenous sedation. Our study investigated the effectiveness of a methoxyflurane inhaler combined with local anesthesia in reducing procedural pain from genicular nerve block compared with local anesthesia alone.

methods42 adults with refractory KOA were randomized into two groups. Methoxyflurane group received a self-titrated methoxyflurane inhaler with local anesthesia whereas lidocaine group received local anesthesia only. The primary outcome was pain score on a 0-10 verbal numerical rating scale (VNRS) during the procedure. Secondary outcomes included changes in VNRS and behavioral pain scale (critical care pain observational tool) during the procedure, hemodynamic changes, anxiety level, sedation score, and adverse events.

results42 patients with a mean age of 66±12 years participated in this study. There were no significant baseline differences. During the procedure, the methoxyflurane group experienced a significantly greater VNRS pain reduction from baseline (2 (1, 4) vs -1 (-2, 0); p<0.01) and greater VNRS reduction over time (p=0.01) compared with the lidocaine group, with a higher sedation score (p<0.01). Immediately postprocedure, anxiety levels were lower in the methoxyflurane group compared with the lidocaine group (median State-Trait Anxiety Inventory score 21 (IQR 20, 24) vs 27 (23, 29); p=0.02), but the median reduction in anxiety level was not significant (6 (1, 12) vs 5 (0, 14); p=0.61). There were no differences in behavioral pain scores, hemodynamic parameters, recovery or discharge times, and adverse effects between the two groups.

conclusionA methoxyflurane inhaler combined with local anesthesia provided better procedural pain control than local anesthesia alone with no observable differences in adverse effects. Future studies evaluating the impact of a methoxyflurane inhaler on different types of painful procedures are warranted.

Indexed as

Anesthetics, InhalationMethoxyfluraneNebulizers and VaporizersNerve BlockOsteoarthritis, KneeProcedural PainAdministration, InhalationAgedAnesthetics, LocalFemaleHumansLidocaineMaleMiddle AgedPain MeasurementTreatment OutcomeAnesthetics, InhalationAnesthetics, LocalLidocaineMethoxyfluraneAmbulatory CareAnalgesiaPharmacology

Identifiers

PMID39174051
PMCPMC12703250

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.