Self-administered inhaled painkiller shows superiority in prehospital setting

A new study has revealed an inhaled analgesic recently introduced to the UK is the most effective form of severe pain relief in the prehospital setting following traumatic injury, in terms of speed of pain reduction.

Treatment during the first hour after trauma is vital to improve patient survival and good analgesia can result in easier injury management and the potential to avoid chronic pain development. Despite this, less than a third of people in UK ambulances are given appropriate pain relief.

The year-long MAPIT study, led by Professor Aloysius Niroshan Siriwardena of the University of Lincoln, UK, and carried out by East Midlands Ambulance Service, showed that the analgesic Penthrox®▼ (methoxyflurane), acts more than three times quicker than the most frequently used – and also inhaled – analgesic, Entonox® (gas and air), more than three times quicker than intravenous paracetamol, and twice as quick as intravenous morphine to reduce severe pain.

Methoxyflurane, which has been dubbed the ‘green whistle’ has already been proven to be a convenient and effective option for pain relief, leading to a significant reduction in time spent in the hospital emergency department. Although it is used regularly in UK emergency departments, it is not widely used in ambulances.

The data from the MAPIT study, was today (Tuesday 23rd March) shared at the 999 EMS Research Forum Annual Conference, providing the first comprehensive UK comparison of analgesic options used by paramedics and emergency medical technicians.

The evidence means prehospital emergency staff can now feel confident when choosing methoxyflurane as a first-line treatment option for moderate-to-severe trauma pain.

Rapid and effective pre-hospital analgesia has the potential to improve the patient journey end-to-end. With the NHS continuing to face an exceptional crisis following the outbreak of COVID-19 and unprecedented levels of pressure to free up resources across all treatment settings, the study results are welcome news.

Chief Investigator, Professor Aloysius Niroshan Siriwardena, commented: “There are many barriers to adequate pain relief. This study is the first to compare methoxyflurane with all other commonly used analgesics in the prehospital setting and the superior results add to the weight of positive findings from other UK and European hospital studies.

“From an academic perspective, it is an important addition to the evidence, and we look forward to seeing how greater uptake impacts patients in other ambulance trusts.”

Dr Leon Roberts, Medical Director for East Midlands Ambulance Service NHS Trust, which carried out the study, commented: “Rapid and effective pain relief is undeniably important in the prehospital setting and this study shows that emergency care staff have access to a well-tolerated treatment, which is easy to administer.

“EMAS is proud to be a leading organisation in prehospital research collaborating with key partners such as the University of Lincoln, who has analysed and evaluated this data.”

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