Skip to main content
SpringerLink
Log in

Literature review on the use of methoxyflurane in the management of pain in cancer-related procedures

  • Review
  • Published:
Supportive Care in Cancer Aims and scope Submit manuscript

Abstract

Introduction

Self-administered methoxyflurane, also known as Penthrox, at a sub-anesthetic dose is a short-term, fast-acting, and safe analgesic that may provide suitable pain relief for cancer patients. This review aims to compile the existing evidence on methoxyflurane and its efficacy in reducing pain during cancer-related procedures.

Methods

A literature search was conducted through OVID Medline and Embase. The search was limited to articles published between 2012 and 2021 and studies were included if they assessed the efficacy of methoxyflurane to reduce pain in cancer-related procedures. All types of cancer were included.

Results

The literature search yielded seven studies published between 2012 and 2021. The studies analyzed assessed methoxyflurane use in prostate biopsy, colonoscopy, removal of brachytherapy rods, and bone marrow biopsy. Various research designs were employed, including three randomized controlled trials, two prospective observational studies, one retrospective, and one non-randomized controlled trial. In all, methoxyflurane has a demonstrated ability to reduce pain in these procedures.

Conclusion

In the limited studies available in evaluating the efficacy of methoxyflurane for reducing procedural pain during cancer-related procedures, all have demonstrated clinical equivalency or superiority. Pain relief appears to be equivalent however methoxyflurane overcomes the standard limitations of respiratory sedation and has demonstrated quicker procedural recovery times than traditional sedation methods. The accumulated data to date supports the use of methoxyflurane which can supplement or supplant current methods of analgesia in cancer-related procedures.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Grummet J, Huang S, Konstantatos A, Frydenberg M (2012) The “green whistle”: a novel method of analgesia for transrectal prostate biopsy. BJU Int 110:85–88. https://doi.org/10.1111/j.1464-410X.2012.11613.x

    Article  PubMed  Google Scholar 

  2. Gaskell AL, Jephcott CG, Smithells JR, Sleigh JW (2016) Self-administered methoxyflurane for procedural analgesia: experience in a tertiary Australasian centre. Anaesthesia 71(4):417–423. https://doi.org/10.1111/anae.13377

    Article  CAS  PubMed  Google Scholar 

  3. Nguyen NQ, Toscano L, Lawrence M, Moore J, Holloway RH, Bartholomeusz D, Lidums I, Tam W, Roberts-Thomson IC, Mahesh VN, Debreceni TL, Schoeman MN (2013) Patient-controlled analgesia with inhaled methoxyflurane versus conventional endoscopist-provided sedation for colonoscopy: a randomized multicenter trial. Gastrointest Endosc 78(6):892–901. https://doi.org/10.1016/j.gie.2013.05.023

    Article  PubMed  Google Scholar 

  4. Lee C, Woo HH (2015) Penthrox inhaler analgesia in transrectal ultrasound-guided prostate biopsy: Penthrox inhaler analgesia in TRUSPB. ANZ J Surg 85(6):433–437. https://doi.org/10.1111/ans.12694

    Article  PubMed  Google Scholar 

  5. Huang S, Pepdjonovic L, Konstantatos A, Frydenberg M, Grummet J (2016) Penthrox alone versus Penthrox plus periprostatic infiltration of local analgesia for analgesia in transrectal ultrasound-guided prostate biopsy. ANZ J Surg 86(3):139–142. https://doi.org/10.1111/ans.12974

    Article  PubMed  Google Scholar 

  6. Spruyt O, Westerman D, Milner A, Bressel M, Wein S (2014) A randomised, double-blind, placebo-controlled study to assess the safety and efficacy of methoxyflurane for procedural pain of a bone marrow biopsy. BMJ Support Palliat Care 4(4):342–348. https://doi.org/10.1136/bmjspcare-2013-000447

    Article  PubMed  Google Scholar 

  7. Hayne D, Grummet J, Espinoza D et al (2021) ‘Pain-free TRUS B’: a phase 3 double-blind placebo-controlled randomized trial of methoxyflurane with periprostatic local anaesthesia to reduce the discomfort of transrectal ultrasonography-guided prostate biopsy (ANZUP 1501). BJU Int 129:591–600. https://doi.org/10.1111/bju.15552

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Greco MT, Roberto A, Corli O, Deandrea S, Bandieri E, Cavuto S et al (2014) Quality of cancer pain management: an update of a systematic review of undertreatment of patients with cancer. J Clin Oncol 32(36):4149–4154. https://doi.org/10.1200/JCO.2014.56.0383

    Article  PubMed  Google Scholar 

  9. Dayan AD (2016) Analgesic use of inhaled methoxyflurane: evaluation of its potential nephrotoxicity. Hum Exp Toxicol 35(1):91–100. https://doi.org/10.1177/0960327115578743

    Article  CAS  PubMed  Google Scholar 

  10. Allison SJ, Docherty PD, Pons D, Chase JG (2021) Methoxyflurane toxicity: historical determination and lessons for modern patient and occupational exposure. N Z Med J 134(1534):76–90

    PubMed  Google Scholar 

  11. Ruff R, Kerr S, Kerr D, Zalcberg D, Stevens J (2018) Occupational exposure to methoxyflurane administered for procedural sedation: an observational study of 40 exposures. BJA 120(6):1435–1437. https://doi.org/10.1016/j.bja.2018.01.029

    Article  CAS  PubMed  Google Scholar 

  12. Jephcott C, Grummet J, Nguyen N, Spruyt O (2018) A review of the safety and efficacy of inhaled methoxyflurane as an analgesic for outpatient procedures. Br J Anaesth 120(5):1040–1048. https://doi.org/10.1016/j.bja.2018.01.011

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Author notes

  1. Samuel Finkelstein and Etinosa Oliogu contributed equally to this work as joint first authors.

  2. Joel Finkelstein and Albert Yee contributed equally to this work as joint senior authors.

Authors and Affiliations

  1. Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada

    Samuel Finkelstein, Etinosa Oliogu, Albert Yee, Lauren Milton, Patrick Henry, Tara Behroozian, Edward Chow & Joel Finkelstein

  2. Division of Orthopaedic Surgery, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada

    Albert Yee, Patrick Henry & Joel Finkelstein

  3. Humber River Hospital, Toronto, ON, Canada

    Leon Rivlin

Authors
  1. Samuel Finkelstein
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Etinosa Oliogu
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Albert Yee
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Lauren Milton
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Leon Rivlin
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Patrick Henry
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Tara Behroozian
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Edward Chow
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Joel Finkelstein
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Samuel Finkelstein: co primary author Etinosa Oliogu: co primary author Albert Yee: editing, manuscript review Lauren Milton: screening of articles PRISMA guidelines, co author Leon Rivlin: conception and design, manuscript review Patrick Henry: literature review, editing Tara Behroozian: screening of articles according to PRISMA guidelines, co author Edward Chow: conception and design, editing Joel Finkelstein: senior responsible investigator, manuscript review, editing.

Corresponding author

Correspondence to Joel Finkelstein.

Ethics declarations

Ethics approval

Ethical approval was not required for this study.

Competing interests

The authors declare no competing interests.

Additional information

Publisher's note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Finkelstein, S., Oliogu, E., Yee, A. et al. Literature review on the use of methoxyflurane in the management of pain in cancer-related procedures. Support Care Cancer 31, 232 (2023). https://doi.org/10.1007/s00520-023-07694-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s00520-023-07694-7

Keywords

Search

Navigation