MetoksyKval: the extent of pre-hospital methoxyflurane administration for acute traumatic pain: focus on economic impact and rationale for use.

backgroundEffective pain management is critical in pre-hospital care, yet many patients still receive suboptimal treatment. Methoxyflurane, a handheld self-administered analgesic, is increasingly used in European ambulance services. Its effectiveness and safety are established, but the reasons for its use in acute pre-hospital settings have received limited attention. This study aimed to explore patterns of use, effectiveness, and economic implications of methoxyflurane in traumatic pain, with particular focus on decision-making and patient satisfaction.

methodsThis prospective observational study in a Norwegian ground ambulance service, conducted from January 15 to July 15, 2024, involved adult patients (aged ≥ 18 years) with moderate to severe traumatic pain treated by the ground ambulance service of Innlandet Hospital Trust. Methoxyflurane was administered at the discretion of the ambulance personnel. Pain intensity scores, demographic characteristics, treatment satisfaction levels, and rationale behind choosing methoxyflurane were recorded.

resultsA total of 48 patients were included (median age 69 years, 58% male), most with fall-related injuries (77%) and fractures (65%). In the corresponding 2022 period, only 41% of patients with an Numeric rating Scale (NRS) pain score ≥ 4 received any analgesia. In this study, methoxyflurane accounted for 7% of such cases but increased overall analgesic costs three-fold. It was selected in 15/48 (31%) cases due to difficult intravenous access, in 15/48 (31%) as a preferred non-opioid option despite NRS ≥ 4, and in 13/48 (27%) to reduce on-scene time. Pain measured on NRS decreased from a median of 8 at baseline to 5 within ten minutes, with 52% achieving sufficient relief without rescue medication. Satisfaction was good or better in 61%, 67% would choose methoxyflurane again, and 90% of personnel reported a strong preference for future use. Adverse events were mild and comparable to earlier studies.

conclusionsMethoxyflurane was viewed as a useful non-intravenous option in settings where rapid analgesia is essential. Although used in only 7% of patients with moderate to severe pain and associated with higher costs, it provided fast pain relief in patients with difficult venous access and when minimising on-scene time was critical. These results support its role as a bridge to longer-acting intravenous analgesia and may help decision-makers identify patient groups most likely to benefit, enabling more targeted and cost-effective implementation.

trial registrationApproved by the Regional Ethics Committee, South East; https://rekportalen.no , ref no. 658708/ 255159 and Data Protection Officer at Innlandet Hospital Trust ref.no 28028904).