Penthrox (methoxyflurane) / Medical Developments International - LARVOL DELTA

METHOXYFLURANE or Virtual Reality Headset vs Standard Analgesic Management for the Reduction of Anterior Shoulder Dislocation (HYPNOLUX) (clinicaltrials.gov) - P4 | N=150 | Recruiting | Sponsor: Centre Hospitalier Universitaire de Nice | Trial completion date: Feb 2025 ➔ Mar 2027 | Trial primary completion date: Nov 2024 ➔ Dec 2026

Trial completion date • Trial primary completion date • Pain

Comparison of inhalational methoxyflurane, intranasal fentanyl, and intravenous morphine for treatment of prehospital acute pain in Norway (PreMeFen): a randomised, non-inferiority, three-arm, phase 3 trial. (PubMed, Lancet) - P3 | "Inhalational methoxyflurane is non-inferior to intranasal fentanyl and intravenous morphine for acute pain management in the prehospital environment, assessed 10 min after administration. Inhalational methoxyflurane serves as a valuable non-intravenous alternative in the early phase of treatment and might bridge the gap to longer-acting analgesics."

Head-to-Head • Journal • P3 data • CNS Disorders • Depression • Pain • Psychiatry

Methoxyflurane: a promising non-intravenous, non-opioid analgesic. (PubMed, Lancet) - No abstract available

Journal • Pain

Analgesic efficacy of inhaled methoxyflurane during transforaminal epidural steroid injection for lumbar radiculopathy: a randomized, double-blind placebo-controlled trial. (PubMed, Asian Spine J) - "Patient satisfaction was significantly higher with methoxyflurane (96.67%) than with placebo. Inhaled methoxyflurane is a safe and effective analgesic for TFESI, offering significant procedural pain reduction and high patient satisfaction, while maintaining a favorable safety profile."

Clinical • Journal • Musculoskeletal Pain • Pain • Xerostomia

Treatment of acute trauma-related pain in children and adolescents with methoxyflurane (Penthrox®) compared to placebo (MAGPIE): A randomised clinical trial. (PubMed, Injury) - P3 | "In this pivotal placebo-controlled trial, methoxyflurane was efficacious for treatment of acute trauma-related pain in paediatrics, with a safety profile consistent with adults."

Journal • Pain • Pediatrics

Beyond the Common: Methoxyflurane as a Cause of Acute Liver Failure (ACG 2025) - "It reduces oligoanalgesia by overcoming barriers of other analgesics like nitrous oxide, ketamine, or opioids...Rare cases of severe hepatotoxicity include a 2010 report after sevoflurane use...This case underscores the importance of prompt recognition. Co-administration of Augmentin might have contributed, highlighting the need for clear medication guidance and strategies to reduce harm.Figure: Portal inflammationFigure: Macrovesicular steatosis"

Anesthesia • Cardiovascular • Gastrointestinal Disorder • Hematological Disorders • Hepatitis C • Hepatology • Inflammation • Liver Failure • Renal Disease

BET: methoxyflurane to facilitate reduction of anterior shoulder dislocation. (PubMed, Emerg Med J) - "The author, date, country of publication, study type, patient characteristics, relevant results and study weaknesses were tabulated. Our results suggest favourable outcomes with methoxyflurane, but a multicentre randomised trial is needed to fully address this clinical question."

Journal • Anesthesia

Sources of Discomfort and Treatment Strategies for Trauma Patients in the Pre-Hospital Setting-A Scoping Review. (PubMed, J Emerg Nurs) - "The findings underline the multidimensional nature of discomfort in prehospital trauma care and highlight effective interventions, including pharmacologic and complementary nonpharmacologic strategies. However, significant gaps remain regarding standardized assessment tools for non-pain-related discomforts and combined interventions. This review underscores the necessity for comprehensive management protocols and further research to optimize patient comfort and care outcomes in trauma settings."

Journal • Mood Disorders • Pain • Psychiatry

Methoxyflurane Instead of Morphine in Acute Coronary Syndrome Patients: Results of the Randomized Controlled METHANE-SIRIO 4 Study. (PubMed, Thromb Haemost) - "Significant differences in median serum concentrations of ticagrelor and its active metabolite were most pronounced between patients treated with ticagrelor and methoxyflurane versus ticagrelor and morphine.Co-administration of methoxyflurane in acute coronary syndrome patients allows for the avoidance of negative effects of morphine and has the additional effect of inhibiting platelet reactivity. Further randomized studies would be recommended to support these findings."

Journal • Acute Coronary Syndrome • Cardiovascular

Comparative analysis of pain control in high-resolution anoscopy Lidocaine versus Methoxyflurane (ESCP 2025) - "Conclusion No significant differences were found in pain levels between patients who received lidocaine and those who received methoxyflurane as anesthesia during high-resolution anoscopy (p = 0.486). This suggests that both anesthetic agents may be equivalent in terms of pain perception during this procedure"

Anal Carcinoma • Anesthesia • Pain • Solid Tumor

Randomized controlled trial comparing the effects of methoxyflurane and local anesthesia combination to local anesthesia alone in scrotal surgery. (PubMed, Can Urol Assoc J) - "Scrotal surgery under LA is well tolerated; however, inhaled methoxyflurane as an adjunct to LA is an effective means of reducing anxiety and further improving patient-reported experiences during scrotal urologic procedures."

Journal • Anesthesia • Pain • Psychiatry

Methoxyflurane for IUD Insertion and Endometrial Biopsy (clinicaltrials.gov) - P=N/A | N=174 | Recruiting | Sponsor: Mount Sinai Hospital, Canada

New trial • Long-acting Reversible Contraceptives

Rotational investigation of volatile anesthetics: Conformational equilibrium, molecular structure, and complex hyperfine interactions of methoxyflurane. (PubMed, J Chem Phys) - "A computational characterization using density functional theory [CAM-B3LYP-D3 (BJ)] complemented the experimental results. This work completes the rotational investigations on the conformational and structural panorama of the most important halogenated inhalational anesthetics, potentially enabling their monitoring through rotational spectroscopic fingerprints."

Journal • Anesthesia

Trial to Assess the Efficacy and Safety During Convective Radiofrequency Water Vapor Thermal Therapy (REZUM) for Benign Prostate Hyperplasia (clinicaltrials.gov) - P3 | N=48 | Not yet recruiting | Sponsor: University of Manitoba

Head-to-Head • New P3 trial • Anesthesia • Benign Prostatic Hyperplasia

PenthroxOTL: Penthrox in Otolaryngology (clinicaltrials.gov) - P=N/A | N=50 | Not yet recruiting | Sponsor: Sir Mortimer B. Davis - Jewish General Hospital

New trial • Anesthesia • Otorhinolaryngology

Effectiveness of Penthrox vs Placebo in Sinus Procedures, a Clinical Trial (clinicaltrials.gov) - P1/2 | N=100 | Recruiting | Sponsor: St. Paul's Hospital, Canada | Trial completion date: Jun 2025 ➔ Jun 2026 | Trial primary completion date: Apr 2025 ➔ Apr 2026

Trial completion date • Trial primary completion date • Otorhinolaryngology • Pain • Respiratory Diseases • Sinusitis

Out-of-hospital neck of femur injury: An eight-year observational analysis. (PubMed, Prehosp Emerg Care) - "According to adjusted analysis, increasing age (Adjusted Odds Ratio (AOR)=1.026, 95% Confidence Interval (CI): 1.021,1.031), paramedic attendance (relative to basic life support-trained personnel, AOR = 3.471 (95%CI 2.921,4.125)), increasing initial pain score (AOR = 1.705 (95%CI 1.665,1.747)), application of a splint (AOR = 1.272 (95%CI 1.147,1.411)) and analgesia administration including opioids and methoxyflurane were associated with clinically meaningful pain reduction...Although most patients with neck of femur fractures reported a clinically meaningful reduction in pain, 30.5% of patients reported moderate to severe pain upon conclusion of out-of-hospital treatment. Expansion of analgesic options available to basic life support-trained patient transport officers, and educating prehospital clinicians on the safety and efficacy of analgesics and splinting practices, represent future opportunities for improvement."

Journal • Musculoskeletal Diseases • Orthopedics • Pain

Effectiveness of inhaled methoxyflurane in acute pain in an emergency department - A systematic review of randomized controlled trials. (PubMed, Am J Emerg Med) - "Inhaled methoxyflurane provides rapid and effective pain relief for acute trauma, consistently outperforming placebo and standard treatments and improving patient and clinician satisfaction."

Journal • Review • Pain

Sevoflurane sedation: blind alley or cunning plan? (PubMed, Br J Anaesth) - "Although a promising concept, it must be demonstrated that patients cannot induce unconsciousness on their own despite any interactions with opioid analgesics. Significant steps remain before practical, patient-controlled sevoflurane sedation can be implemented."

Journal • Anesthesia • Pain

A Randomized Controlled Trial of Inhaled Methoxyflurane as an Adjunct to Local Anesthesia in Scrotal Urologic Surgery (AUA 2025) - "The results demonstrate that methoxyflurane, as an adjunct to local anesthesia reduces intra-operative pain and anxiety during scrotal surgeries. This combination enhances the overall experience for patients undergoing outpatient urologic procedures. Further research with larger sample sizes is necessary to validate these findings and assess the long-term safety of methoxyflurane in this context."

Clinical • Surgery • Anesthesia • Pain • Psychiatry • Urology

Penthrox®: the use of inhaled methoxyflurane for analgesia in transperineal prostate biopsies (AUA 2025) - "Our study has demonstrated a statistically significant improvement in pain scores in men using Penthrox in addition to standard LA infiltration for transperineal prostate. This has the potential to improve patient's experiences in what can often be the first step of the rocky path of their prostate cancer journey. These promising findings call for a multi-centre blinded randomised trial to investigate this at scale."

Biopsy • Genito-urinary Cancer • Oncology • Pain • Prostate Cancer • Solid Tumor • Urology

A comparative analysis of local anesthesia, nursing-administered conscious sedation, and deep intravenous sedation for penile plication surgery: patient tolerability and outcomes (AUA 2025) - "The anesthetic options evaluated included LA with oral sedation (methoxyflurane), NACS with midazolam and fentanyl, and DIS with midazolam, ketamine, propofol, and remifentanil. Penile plication is well tolerated when performed using LA with oral sedation, NACS, or DIS, with no significant differences in pain or complication rates between methods. All three anesthetic approaches are viable for outpatient penile plication, offering potential benefits such as reduced costs, minimized risks, and shorter wait times."

Clinical • Surgery • Anesthesia • Pain • Rheumatology

Inhaled methoxyflurane in patients with cancer: current applications and future directions. (PubMed, Curr Opin Support Palliat Care) - "IMF is a safe drug device combination that can reduce discomfort and improve treatment compliance with repeat procedures in cancer patients. Real-world studies should be performed to further evaluate its safety and quality of life in diverse cancer patient populations and guide patient selection."

Journal • Anesthesia • Mood Disorders • Oncology • Pain • Psychiatry

Methoxyflurane for Analgesia During Hysteroscopy (clinicaltrials.gov) - P=N/A | N=54 | Not yet recruiting | Sponsor: Dr. John A. Thiel Medical Professional Corporation

New trial • Anesthesia • Gynecology

Greenhouse gas impact from medical emissions of halogenated anaesthetic agents: a sales-based estimate. (PubMed, Lancet Planet Health) - "The global greenhouse gas impact from halogenated anaesthetic agents is falling due to lower use of desflurane in high-income countries. Efforts to reverse the increased use of desflurane in middle-income countries are needed. Replacing desflurane and isoflurane with sevoflurane constitutes an opportunity to markedly reduce the greenhouse gas impact from halogenated anaesthetic agents."

Journal • Anesthesia