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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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Martinez Avila, Jose CarlosAuthor

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November 21, 2022
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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

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

Authors: 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

Affiliations

Complejo Asistencial Zamora, Zamora, Spain - Author
Hosp Bierzo, Ponferrada, Spain - Author
Hosp Campo Grande, Valladolid, Spain - Author
Hosp Clin San Carlos, Madrid, Spain - Author
Hosp Gen Alicante, Alicante, Spain - Author
Hosp Gernika Lumo, Gernika Lumo, Spain - Author
Hosp Monograf Asepeyo Traumatol Cirugia & Rehabil, Coslada, Spain - Author
Hosp Univ Alvaro Cunqueiro, Vigo, Spain - Author
Hosp Univ La Princesa, Madrid, Spain - Author
Hosp Univ Puerta Hierro Majadahonda, Madrid, Spain - Author
Hosp Viladecans, Barcelona, Spain - Author
Hosp Virgen Rocio, Seville, Spain - Author
Mundipharma Pharmaceut SL, Madrid, Spain - Author
Spanish Clin Res Network, Madrid, Spain - Author
SUMMA 112, Madrid, Spain - Author
Univ Autonoma Madrid, Hosp Univ La Paz, Sch Med, Hosp La Paz Inst Hlth Res, Madrid, Spain - Author
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Abstract

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.

Keywords

Acute painAdministration, inhalationAgedAnalgesiaAnalgesicsAnesthetics, inhalationDouble-blindEfficacyEmergency service, hospitalFemaleHumansIntensityMaleMethoxyfluraneMiddle agedPain managementPain measurementPrevalenceSafetyWounds and injuries

Quality index

Bibliometric impact. Analysis of the contribution and dissemination channel

The work has been published in the journal Annals Of Emergency Medicine due to its progression and the good impact it has achieved in recent years, according to the agency WoS (JCR), it has become a reference in its field. In the year of publication of the work, 2020, it was in position 1/32, thus managing to position itself as a Q1 (Primer Cuartil), in the category Emergency Medicine. Notably, the journal is positioned above the 90th percentile.

From a relative perspective, and based on the normalized impact indicator calculated from World Citations provided by WoS (ESI, Clarivate), it yields a value for the citation normalization relative to the expected citation rate of: 3.77. This indicates that, compared to works in the same discipline and in the same year of publication, it ranks as a work cited above average. (source consulted: ESI Nov 14, 2024)

This information is reinforced by other indicators of the same type, which, although dynamic over time and dependent on the set of average global citations at the time of their calculation, consistently position the work at some point among the top 50% most cited in its field:

  • Weighted Average of Normalized Impact by the Scopus agency: 4.3 (source consulted: FECYT Feb 2024)
  • Field Citation Ratio (FCR) from Dimensions: 16.33 (source consulted: Dimensions Jul 2025)

Specifically, and according to different indexing agencies, this work has accumulated citations as of 2025-07-09, the following number of citations:

  • WoS: 38
  • Scopus: 43
  • Europe PMC: 17

Impact and social visibility

From the perspective of influence or social adoption, and based on metrics associated with mentions and interactions provided by agencies specializing in calculating the so-called "Alternative or Social Metrics," we can highlight as of 2025-07-09:

  • The use, from an academic perspective evidenced by the Altmetric agency indicator referring to aggregations made by the personal bibliographic manager Mendeley, gives us a total of: 152.
  • The use of this contribution in bookmarks, code forks, additions to favorite lists for recurrent reading, as well as general views, indicates that someone is using the publication as a basis for their current work. This may be a notable indicator of future more formal and academic citations. This claim is supported by the result of the "Capture" indicator, which yields a total of: 172 (PlumX).

With a more dissemination-oriented intent and targeting more general audiences, we can observe other more global scores such as:

  • The Total Score from Altmetric: 80.45.
  • The number of mentions on the social network X (formerly Twitter): 36 (Altmetric).
  • The number of mentions in news outlets: 5 (Altmetric).