Efficacy of Inhaled Methoxyflurane for Acute Trauma Pain Management: A Systematic Review and Meta-Analysis.

Background

Acute traumatic pain is common in emergency settings and inadequate analgesia can worsen physiological, psychological, and functional outcomes. STUDY

Objectives

This systematic review and meta-analysis evaluated the efficacy, onset of action, safety, and clinical practicality of inhaled methoxyflurane compared with control analgesic treatments for acute trauma-related pain.

Methods

Four databases were searched from inception through February 2026. Randomized controlled trials evaluating inhaled methoxyflurane for acute traumatic pain were eligible. Outcomes included visual analogue scale and numerical rating scale pain scores, rescue analgesia, time to first pain relief, and adverse events (AEs). Risk of bias was assessed with the Cochrane Risk of Bias 2 tool, and RevMan was used for quantitative synthesis.

Results

Seven studies involving 1585 participants were analyzed. Methoxyflurane significantly reduced the time to first pain relief compared with controls (mean difference -5.93 min, 95% confidence interval [CI] -6.86 to -5.00, p < 0.00001, I2 = 0%). Pain intensity also favored methoxyflurane at 5, 10, 15, and 20 min. Methoxyflurane also significantly reduced the need for rescue analgesia (risk ratio 0.40, 95% CI 0.18-0.90, p = 0.03). Overall AEs were comparable, but dizziness, drowsiness, and cough were more frequent with methoxyflurane.

Conclusion

Inhaled methoxyflurane provides rapid and effective analgesia for acute traumatic pain and may reduce rescue analgesia needs. Further high-quality randomized trials are needed to clarify comparative effectiveness across trauma populations and emergency care settings.