Academic Department of Military General Practice & Primary Care, Research and Clinical Innovation, Royal Centre for Defence Medicine, HQ Joint Medical Group, ICT Centre, Vincent Drive, Edgbaston, Birmingham, B15 2SQ, UK.
Department of Anaesthetics and Critical Care, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Trust, Mindelsohn Way, Edgbaston, B15 2TH, UK.
Syst Rev. 2021 Feb 3;10(1):47. doi: 10.1186/s13643-021-01600-0.
More than 75% of patients presenting to the Emergency Department are suffering symptoms of pain. Despite this, 67% will not receive any analgesia. Methoxyflurane is a fluorinated hydrocarbon gas which has analgesic properties when inhaled. Penthrox is a methoxyflurane autoinhaler recently licenced in Europe. Its ease of administration, safety, and fast onset of action make it of particular relevance to emergency medicine. Additionally, outside the hospital, it has the advantage of increased temperature stability and portability over current standard care. New evidence of its efficacy is emerging; however, currently, its use in Europe is not widespread. The objective of this study will be to systematically evaluate the evidence on inhaled methoxyflurane to determine if it is a superior analgesia in the acute trauma setting.
We designed and registered a study protocol for a systematic review and meta-analysis on randomised controlled trials, comparing inhaled methoxyflurane and either placebo or standard care. A comprehensive search will be conducted from database inception onwards in MEDLINE, Embase, and the Cochrane CENTRAL database, concurrent with a search of the grey literature for other relevant studies, including clinical trial databases. Only randomised controlled trials will be included. No limitations will be imposed on publication status or language of publication. The primary outcome will be mean difference in patient-reported pain at time points within the first 30 min of administration. Secondary outcomes will be mean difference in time to clinically significant pain relief and relative risk of adverse effects. Two reviewers will independently screen all returned studies and collect data. Disagreements will be resolved through discussion or referral to a third reviewer. Individual study methodological quality will be appraised using an appropriate tool. If feasible, we will conduct a random effects meta-analysis; if this is not possible, we will construct a narrative synthesis.
This systematic review will summarise the best available evidence and definitively establish if inhaled methoxyflurane is a superior analgesia to standard care in the acute trauma setting. This knowledge will directly impact emergency care in the UK and worldwide and may require amendments to European pain relief guidelines.
PROSPERO CRD42020189119 .
超过 75%的急诊科就诊患者都有疼痛症状。尽管如此，仍有 67%的患者未接受任何镇痛治疗。甲氧氟烷是一种吸入时有镇痛作用的含氟碳氢化合物气体。戊烷脒是一种最近在欧洲获得许可的甲氧氟烷自动吸入器。它的给药简便、安全性高、起效迅速，这使其在急诊医学中具有特殊意义。此外，在医院外，它在温度稳定性和便携性方面优于目前的标准护理。新的证据表明其具有疗效；然而，目前在欧洲，它的使用并不广泛。本研究的目的是系统评估吸入甲氧氟烷的证据，以确定其在急性创伤环境中是否是一种更好的镇痛剂。
我们设计并注册了一项关于随机对照试验的系统评价和荟萃分析的研究方案，比较吸入甲氧氟烷与安慰剂或标准护理的效果。我们将从数据库建立之初开始，在 MEDLINE、Embase 和 Cochrane CENTRAL 数据库中进行全面搜索，并同时在灰色文献中搜索其他相关研究，包括临床试验数据库。仅纳入随机对照试验。不限制发表状态或语言。主要结局是在给药后 30 分钟内患者报告的疼痛的平均差异。次要结局是临床显著疼痛缓解的平均差异和不良反应的相对风险。两位评审员将独立筛选所有返回的研究并收集数据。意见分歧将通过讨论或提交给第三位评审员解决。将使用适当的工具评估个别研究的方法学质量。如果可行，我们将进行随机效应荟萃分析；如果不可行，我们将进行叙述性综合。
这项系统评价将总结最佳现有证据，并明确确定在急性创伤环境中，吸入甲氧氟烷是否优于标准护理。这一知识将直接影响英国和全球的急诊护理，并可能需要对欧洲疼痛缓解指南进行修订。
PROSPERO CRD42020189119。
