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By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org).The study was funded by Mundipharma Pharmaceuticals S.L. but was designed, conducted, and analyzed by the coordinators of the Pain Group of the Spanish Society of Emergency Medicine (SEMES) and representatives of the SCReN. Costs for article processing and Open Access were funded by Mundibiopharma Limited The Scientific Committee of the study comprises members of SEMES and SCReN. The SCReN, PT13/0002, is funded by the Plan Estatal of Investigacion, Desarrollo e Innovacion 2013-2016 and by the Subdireccion General de Evaluacion y Fomento de la Investigacion-Instituto de Salud Carlos III. It is also cofinanced with funding from FEDER. Drs. Borobia, Capilla Pueyo, Carcas Sansuan, Casal Codesido, Fernandez Testa, and Martinez Avila received fees as members of the trial scientific committee. Drs. Borobia, Capilla Pueyo, Corell Gonzalez, Fernandez Alonso, Fernandez Testa, Garcia Collado, and Perez Torres received fees as speakers. Susana Traseira Lugilde is an employee of Mundipharma Pharmaceuticals S.L. Support for Ms. Mower was funded by Mundipharma Research Limited.

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Inhaled Methoxyflurane Provides Greater Analgesia and Faster Onset of Action Versus Standard Analgesia in Patients With Trauma Pain: InMEDIATE: A Randomized Controlled Trial in Emergency Departments

Publicat a:Annals Of Emergency Medicine. 75 (3): 315-328 - 2020-03-01 75(3), DOI: 10.1016/j.annemergmed.2019.07.028

Autors: Borobia, Alberto M; Garcia Collado, Sergio; Carballo Cardona, Cesar; Capilla Pueyo, Rosa; Fernandez Alonso, Cesareo; Perez Torres, Ignacio; Corell Gonzalez, Maria; Casal Codesido, Jose Ramon; Arranz Betegon, Maria; Amador Barcela, Luis; Odiaga Andicoechea, Aitor; Fernandez Testa, Anselma; Trigo Colina, Jorge; Cid Dorribo, Antonio; del Arco Galan, Carmen; Martinez Avila, Jose Carlos; Traseira Lugilde, Susana; Carcas Sansuan, Antonio J

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Study objective: The objective of the InMEDIATE study was to evaluate the change in intensity of traumatic pain over the first 20 min in adult patients treated with methoxyflurane versus standard analgesic treatment in Spain. This the first randomized, active-controlled, multicenter trial of methoxyflurane in the emergency setting in Europe.Methods: This was a randomized, controlled study that enrolled adult patients with acute moderate to severe (score >= 4 on the 11-point Numeric Rating Scale) trauma-associated pain in 14 Spanish emergency departments. Patients were randomized 1:1 to methoxyflurane (up to 2x3 mL) or standard analgesic treatment. Coprimary endpoints were the change from baseline in Numeric Rating Scale pain intensity score during the first 20 minutes of treatment and time to first pain relief.Results: Three hundred five patients were randomized (methoxyflurane 156; standard analgesic treatment 149). Most patients in the standard analgesic treatment group (70%) received intravenous first-step analgesics and 9.4% of patients were treated with opioids. Mean decrease from baseline in Numeric Rating Scale pain intensity score was greater for methoxyflurane than standard analgesic treatment at all points, with a significant treatment difference overall up to 20 minutes (repeated-measures model 2.47 versus 1.39; treatment difference 1.00; 95% confidence interval 0.84 to 1.32). Median time to first pain relief was significantly shorter for methoxyflurane than standard analgesic treatment (3 versus 10 minutes). Methoxyflurane achieved better patient and clinician ratings for pain control and comfort of treatment than standard analgesic treatment and exceeded patient and clinician expectations of treatment in, respectively, 77% and 72% of cases compared with 38% and 19% for standard analgesic treatment.Conclusion: These results support consideration of methoxyflurane as a nonnarcotic, easy-to-administer, rapid-acting, first-line alternative to currently available analgesic treatments for trauma pain.

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