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

2. Clinical Need
Inherent need to offer patients analgesia for existing or potential pain
Current options:
Local anaesthetics, oral analgesics, narcotics
and …
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3. 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)

4. 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
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5. 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

6. 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

7. Intermittent Usage of Methoxyflurane
Use intermittently as needed, or just before planned possible painful stage during intervention

8. Assisting the Patient to Manage Pain
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

9. 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
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10. 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

11. Case Series (Buntine): Results
Statistically significant reduction in pain scores compared with baseline (p < )

12. 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

13. 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

14. 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

15. Clinical Poster (Wilkes and Oxer): Results
Good / excellent relief
Partial relief
No relief
Methoxyflurane
54.3%
38.4%
7.3%
Intra-nasal fentanyl
52.9%
39.8%
7.4%
No significant side effects reported
Methoxyflurane particularly useful in children
Analgesia from methoxyflurane found to be equivalent to intra-nasal fentanyl

16. Examples of Use – Ambulance and Rescue
Physical trauma
Domestic trauma
Motor vehicle accidents
Pain / injury
Mass casualty
Emergency rescue

17. Hospital Accident and emergency Minor surgical procedures
Burns / wound management
Radiology
Oncology
Acute pain services
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18. First Response Worksite injuries Sporting injuries
Injuries at mass public
gatherings
Physical trauma
Mass Trauma
Remote Areas

19. 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

21. Potential Population Patients who may benefit include those: In pain
Anxious
Pain intolerant
Dislike of needles or injections
Uncooperative
Preparing for a painful
procedure

22. Summary
Methoxyflurane has been clinically demonstrated over many years to be a safe and effective agent offering patients comfort and relief from pain
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