We aimed to investigate clinical benefits and economic costs of inhaled methoxyflurane when used by ambulance staff for prehospital emergency patients with trauma. Comparison is to usual analgesic practice (UAP) in the UK in which patient records were selected if treatment had been with Entonox® or intravenous morphine or intravenous paracetamol. Over a 12-month evaluation period, verbal numerical pain scores (VNPS) were gathered from adults with moderate to severe trauma pain attended by ambulance staff trained in administering and supplied with methoxyflurane. Control VNPS were obtained from ambulance database records of UAP in similar patients for the same period. Statistical modelling enabled comparisons of methoxyflurane to UAP, where we employed an Ordered Probit panel regression model for pain, linked by observational rules to VNPS. Overall, 96 trained paramedics and technicians from the East Midlands Ambulance Service NHS Trust (EMAS) prepared 510 doses of methoxyflurane for administration to a total of 483 patients. Comparison data extracted from the EMAS database of UAP episodes involved: 753 patients using Entonox®, 802 patients using intravenous morphine, and 278 patients using intravenous paracetamol. Modelling results included demonstration of faster pain relief with inhaled methoxyflurane (all p-values < 0.001). Methoxyflurane’s time to achieve maximum pain relief was estimated to be significantly shorter: 26.4 min (95%CI 25.0–27.8) versus Entonox® 44.4 min (95%CI 39.5–49.3); 26.5 min (95%CI 25.0–27.9) versus intravenous morphine 41.8 min (95%CI 38.9–44.7); 26.5 min (95%CI 25.1–28.0) versus intravenous paracetamol 40.8 (95%CI 34.7–46.9). Scenario analyses showed that durations spent in severe pain were significantly less for methoxyflurane. Costing scenarios showed the added benefits of methoxyflurane were achieved at higher cost, eg versus Entonox® the additional cost per treated patient was estimated to be £12.30. When administered to adults with moderate or severe pain due to trauma inhaled methoxyflurane reduced pain more rapidly and to a greater extent than Entonox® and parenteral analgesics. Inclusion of inhaled methoxyflurane to the suite of prehospital analgesics provides a clinically useful addition, but one that is costlier per treated patient.

中文翻译：

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吸入甲氧氟烷与常规镇痛治疗院前损伤和创伤的有效性和成本评估：非随机临床研究

我们的目的是调查救护人员在院前急救创伤患者中使用吸入甲氧氟烷的临床效益和经济成本。与英国的常规镇痛实践 (UAP) 进行比较，其中如果使用 Entonox® 或静脉注射吗啡或静脉注射扑热息痛进行治疗，则选择患者记录。在 12 个月的评估期内，收集了患有中度至重度创伤性疼痛的成人的言语数字疼痛评分 (VNPS)，救护车工作人员接受过管理培训并提供甲氧氟烷。对照 VNPS 是从同一时期类似患者 UAP 的救护车数据库记录中获得的。统计模型可以将甲氧氟烷与 UAP 进行比较，其中我们采用了疼痛的有序概率面板回归模型，并通过观察规则与 VNPS 联系起来。总体而言，来自东米德兰兹救护车服务 NHS 信托基金 (EMAS) 的 96 名训练有素的护理人员和技术人员准备了 510 剂甲氧氟烷，用于总共 483 名患者的给药。从 EMAS 数据库中提取的 UAP 发作比较数据涉及：753 名使用 Entonox® 的患者、802 名使用静脉注射吗啡的患者和 278 名使用静脉注射扑热息痛的患者。建模结果包括证明吸入甲氧氟烷可以更快地缓解疼痛（所有 p 值 < 0.001）。据估计，甲氧氟烷达到最大程度缓解疼痛的时间显着缩短：26.4 分钟 (95% CI 25.0–27.8)，而 Entonox® 为 44.4 分钟 (95% CI 39.5–49.3)；26.5 分钟 (95% CI 25.0–27.9) 对比静脉注射吗啡 41.8 分钟 (95% CI 38.9–44.7)；26.5 分钟 (95% CI 25.1–28.0) 对比静脉注射扑热息痛 40.8 (95% CI 34.7–46.9)。情景分析表明，使用甲氧氟烷后，剧烈疼痛的持续时间显着缩短。成本情景显示，甲氧氟烷的额外益处是以更高的成本实现的，例如，与 Entonox® 相比，每位治疗患者的额外成本估计为 12.30 英镑。当给予因创伤而患有中度或重度疼痛的成年人时，吸入甲氧氟烷比 Entonox® 和肠外镇痛药能更快、更大程度地减轻疼痛。将吸入甲氧氟烷纳入院前镇痛药套件中提供了临床上有用的补充，但每个治疗患者的费用更高。