PENTHROX™ - Methoxyflurane History and Experience in the Management of Pain.

PENTHROX™ - MethoxyfluraneHistory and Experience in the Management

of Pain

Clinical Need

Inherent need to offer patients analgesia for existing or potential pain

Current options:• Local anaesthetics, oral analgesics, narcotics

and …

Clinical Need

Current analgesic options may be less than ideal due to:

• Limited efficacy• Inconvenient administration• Length of onset or duration of action• Adverse reactions (e.g., respiratory depression)

Methoxyflurane

• Originally a general anaesthetic agent • Now Contraindicated due to safety concerns with dose

• Unique in producing powerful analgesic properties at very low sub-anaesthetic concentrations

• Currently indicated for trauma and minor surgical procedures

• Needs NO pre-medication

or fasting

Features of Methoxyflurane

• Potent analgesic with rapid onset

(6 – 10 breaths)

• Demonstrated cardiovascular and

respiratory stability

• No significant adverse effects

• Can be administered easily to patients

of virtually all ages

Penthrox™ Inhaler

The Penthrox™ Inhaler is a tubular light-weight disposable inhaler device that features:

• Internal wick (absorption matrix)• Dilutor hole enables two concentrations• One-way valve to prevent blow-back• 22mm mouthpiece – connects to face

mask

Penthrox given intermittently

0

20

40

60

80

100

1 4 7 10 13 16 19 22 25 28

Possibly Minutes

% 0

f ana

lges

ic s

erum

leve

l

6 breaths 6 breaths 6 breaths

Intermittent Usage of Methoxyflurane

• Use intermittently as needed, or just before planned possible painful stage during intervention

• Best to empower the patient to self-administer intermittently

• Gentle assistance/direction as needed

• Patient may close eyes as they relax, rarely drowsy – easily roused

• Recovery is quick

Assisting the Patient to Manage Pain

Clinical Studies

The analgesic safety and efficacy of methoxyflurane has been evaluated in a variety of areas:

• Pre-hospital• Emergency• Burns• Dental• Obstetrics• Aesthetic surgery

Case Series (Buntine, 2007)

• 83 adult patients receiving paramedical assistance and transport to urban teaching hospital

• Age range = 17 to 95 years

• Methoxyflurane administered via Penthrox™ Inhaler

• Administration duration = median of 29 minutes

• Indication included musculoskeletal injury, visceral pain and back pain

Case Series (Buntine): ResultsStatistically significant reduction in pain scores compared with baseline (p < 0.0001)

Case Series (Babl, 2006):

• 105 paediatric patients receiving paramedical assistance and transport to tertiary children’s hospital

• Age range = 15 months to 17 years

• Methoxyflurane administered via Penthrox Inhaler

• Administration duration = median of 20 minutes

• No pre-medications, no food or fluid restrictions

Case Series (Babl): Results• Methoxyflurane administration resulted in a 43.0%

reduction in pain scores within 10 minutes

• 88.5% of paramedics were satisfied to very satisfied with the level of patient analgesia

• 87.0% of patients were satisfied to very satisfied with the level of analgesia

• 96.9% of primary care providers and older patients would want to use Methoxyflurane again for pain control

Clinical Poster (Wilkes and Oxer, 2007):

• 17,344 patients receiving paramedical assistance and transport to hospital

• Age range = 2 years to 95+ years

• Methoxyflurane administered via Penthrox Inhaler = 13,313 patients

• Fentanyl administered intra-nasally = 4,021 patients

• No pre-medications, no food or fluid restrictions

Clinical Poster (Wilkes and Oxer): Results

• No significant side effects reported

• Methoxyflurane particularly useful in children

• Analgesia from methoxyflurane found to be equivalent to intra-nasal fentanyl

Good / excellent relief

Partial relief No relief

Methoxyflurane 54.3% 38.4% 7.3%

Intra-nasal fentanyl

52.9% 39.8% 7.4%

Examples of Use – Ambulance and Rescue• Physical trauma

• Domestic trauma

• Motor vehicle accidents

• Pain / injury

• Mass casualty

• Emergency rescue

Hospital

• Accident and emergency

• Minor surgical procedures

• Burns / wound management

• Radiology

• Oncology

• Acute pain services

First Response

• Worksite injuries

• Sporting injuries

• Injuries at mass public

gatherings

• Physical trauma

• Mass Trauma

• Remote Areas

Methoxyflurane Use – Severe Burns

• Patient with severe burns and excruciating pain – immersed in water to cool

• Immediate relief from suffering

• watch patient’s face

• Clinical team can immediately treat patient

Potential PopulationPatients who may benefit include those:

• In pain

• Anxious

• Pain intolerant

• Dislike of needles or injections

• Uncooperative

• Preparing for a painful

procedure

Summary

Methoxyflurane has been clinically

demonstrated over many years to be a

safe and effective agent offering patients

comfort and relief from pain