Prehospital Analgesia in Adults Using Inhaled Methoxyflurane : A Feasibility Study

Pain is common and can contribute to both psychological and physiological effects if not treated. Currently primary care paramedics have limited selections within their pain management tool box. This contributes to inadequate pain management. Methoxyflurane is a safe, easy and effective choice in prehospital management of pain. The impact of this feasibility trial, will hope to inform the larger multi-centred trial and then support the implementation of out-of-hospital Canadian National Guidelines for prehospital pain control, enabling paramedics to provide rapid, effective prehospital pain relief to patients.

This will be a single-centred prehospital prospective observational feasibility study to evaluate the ability to perform a multicentred step wedge design trial. The feasibility outcomes will provide evidence for the development of the multicentred study and will capture clinical metrics to inform this larger study. A waver of consent will be sought from the ethics board with participation consent for paramedics understanding the risk of using a gas for analgesia. Patient >= 18 years of age with traumatic pain with a verbal score >= to 4 will be enrolled.

Feasibility study to inform the multicentred prehospital prospective observational step wedge design trial

Methoxyflurane will be introduced and data will be captured to inform future multicentred step wedge design study. (This study is a feasibility study)

Methoxyflurane 3mls will be self administered by patients meeting the inclusion criteria with acute traumatic pain scores >=4

For length of study, up to 100 patients specifically from patient contact to transfer of care in the emergency department

Need for rescue medication (as defined by addition of any other pain medication after methoxyflurane administration, during paramedic care)

For length of study, up to 100 patients. specifically from patient contact to transfer of care in the emergency department

For length of study, up to 100 patients. Specifically time from patient contact to first inhalation of methoxyflurane

Vital signs including (Heart rate, Blood pressure, Respiratory rate, Oxygen saturation, Temperature, Glasgow Coma Scale (GCS))

Example: any advanced airway interventions, oxygen requirement (oxygen saturations <94%), drop in blood pressure by 40% and/or <90 systolic, complaints of nausea or vomiting, malignant hyperthermia reaction).

Inclusion Criteria: >=18 years of age Acute pain from traumatic injury numeric pain score >=4 Exclusion Criteria: Allergy or sensitivity to methoxyflurane History or family history of malignant hyperthermia Pregnant or breast-feeding patients Known renal impairment Known liver disease Methoxyflurane use within previous 3 months