Multimodal oral analgesia for non-severe trauma patients: evaluation of a triage-nurse directed protocol combining methoxyflurane, paracetamol and oxycodone

Abstract

Insufficient analgesia affects around 50% of emergency department patients. The use of a protocol helps to reduce the risk of oligoanalgesia in this context. Our objective was to describe the feasibility and efficacy of a multimodal analgesia protocol (combining paracetamol, oxycodone, and inhaled methoxyflurane) initiated by triage nurse. We performed a prospective, observational study in an emergency department (Grenoble Alpes University Hospital, France) between December 2017 and April 2018. Adult non-severe trauma patients with a numerical pain rating scale (NRS) score ≥ 4 were included. The primary efficacy criterion was the proportion of patients with an NRS score ≤ 3 at 15 min. Pain intensity was measured for 60 min and during radiography. Data on adverse events and satisfaction were recorded. A total of 200 adult patients were included (median [interquartile range (IQR)] age: 32 [23–49] years; 126 men (63%)). Sixty-six patients (33%) reported an NRS score ≤ 3 at 15 min. The time required to achieve a decrease of at least 2 points in the NRS score was 10 (5–20) min. The median [IQR] pain intensity was 4 [2–5] before radiography and 4 [2–6] during radiography. Adverse events were frequent (n = 128, 64%). No serious adverse events were reported. The patients and caregivers reported good levels of satisfaction. The administration of a nurse-driven multimodal analgesia protocol (combining paracetamol, oxycodone, and methoxyflurane) was feasible on admission to the emergency department. It rapidly produced long-lasting analgesia in adult trauma patients.

Trial registration: NCT03380247

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Acknowledgements

Authors thank Ms Johanna Robertson (Grenoble Alpes University Hospital) for critically editing the manuscript.

Funding

This study was partly funded by Mundipharma, a pharmaceutical company that market methoxyflurane across Europe.

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Correspondence to Maxime Maignan.

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Conflict of interest

MM and CMD received fees from Mundipharma (MM and CMD) and Purdue (MM), two pharmaceutical companies that market methoxyflurane. We confirm that the remaining authors have no known conflicts of interest associated with this publication.

Research involving human participants

The study was approved by the local independent ethics committee (CPP SudEst, Grenoble, France; reference: 38RC17.157) and was registered at ClinicalTrial.gov (NCT03380247).

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Signed informed consent was obtained from all individual participants included in the study.

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Viglino, D., Termoz Masson, N., Verdetti, A. et al. Multimodal oral analgesia for non-severe trauma patients: evaluation of a triage-nurse directed protocol combining methoxyflurane, paracetamol and oxycodone. Intern Emerg Med 14, 1139–1145 (2019). https://doi.org/10.1007/s11739-019-02147-8

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Keywords

  • Analgesia
  • Trauma
  • Emergency
  • Nurse-driven protocol
  • Methoxyflurane