213: Methoxyflurane versus Midazolam for Pain Procedures: Patient and Operator Centric Evaluation.

Topic: Clinical Science
Subtopic: Non-specific to any diagnosis, Pharmacological treatments, Pain in Special Populations , Treatment/management

Background and Aims: Background –
Up to 20% of pain procedures require sedation and additional analgesia. Midazolam is the most commonly used agent to achieve this by providing deeper sedation and slower recovery.
Methoxyflurane is an inhaled anaesthetic agent that is a potential alternative.
Methoxyflurane is already used in prehospital scenarios, and emergency department- to provide safe and self administered procedural sedation.

Aim –
To evaluate the effectiveness and safety of Methoxyflurane versus Midazolam during pain procedures using patient and operator reported outcomes.

Methods: We conducted a “Prospective Observational comparative study” involving a total of 50 patients with 25 in each group.
Outcomes were assessed using a structured Patient and Operator centric questionnaires given to the patients after the procedure.
It included desired (easy to use, sedative, anxiolytic, analgesic) effects and undesired (nausea, drowsiness, headache) effects.
Questions were scaled from 1- 10; where 1 meant – helpful outcome and 10 meant not helpful outcome.
Data was summarised descriptively and compared between the two groups.

Results: This comparative study evaluated the profile of methoxyflurane and midazolam for pain procedures using patient and operator centric questionnaires amongst 50 patients – with 25 in each group.
Procedural completion was 100% in both the groups.
Primary outcome - Patient centric questionnaire demonstrated higher satisfaction and anxiolytic effect in methoxyflurane group, a similar sedative and analgesic effect amongst the two groups, with more drowsiness in the midazolam group.
Secondary outcome - Operator centric questionnaire demonstrated similar satisfaction in both the groups.
No serious adverse events noted.

Conclusions: In patients receiving pain intervention under sedation, Methoxyflurane demonstrated higher patient satisfaction and anxiolysis, faster recovery and comparable analgesic and sedative effect. Other benefits included no need for intravenous access or pre- procedure fasting.
Both groups had comparable operator satisfaction.

References: Gaskell AL, Jephcott CG, Smithells JR, Sleigh JW. Self-administered methoxyflurane for procedural analgesia: experience in a tertiary Australian centre. Anaesthesia.2016;71(4): 417-423.

Jephcott C, Grummet J, Nguyen N, Spruyt O. A review of the safety and efficacy of inhaled methoxyflurane as an analgesic for outpatient procedures. Br J Anaesth. 2018;120(5): 1040-1048.

Dias AV, Zeidan Z, Copp M, Eslabra F, Hassan R, Middleton R. Penthrox is an effective analgesic but is it patient approved? BJS. 2023; 110.

Presenting Author: Dr. Gargee Bhatt
Submitting Author: Gargee Bhatt

Senior Author: Dr. James Jack

IASP 2026 Global Year theme of Neuropathic Pain: No

• Dr. Bustamante: FRCA FFPMRCA - GESH
• Dr. Samina Shah: FRCA, FFPMRCA - GESH