Penthrox: Pour la sédation procédurale ?

Inhaled methoxyflurane for the reduction of acute anterior shoulder dislocation in the emergency department.

Umana E et Al. CJEM. 2019 Jul;21(4):468-472. doi: 10.1017/cem.2018.493. Epub 2019 Feb 11.

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Le methoxyflurane est proposé comme agent d'analgésie avec pour avantage une relative simplicité de mise en oeuvre mais aussi son auto-administration par le patient lui même. Bien que moins efficace que d'autres agents tel que le propofol, son emploi pour la réalisation de gestes douloureux est également proposé avec pour avantage une moindre sédation post procédure. C'est ce que décrit avec succès cet article à propos d'un geste courant: la réduction de luxation d'épaule. Un petit bémol, le méthoxyflurane est un agent d'anesthésie ayant des propriétés sédatives importante qui sont minimisée avec le mode d'administration du Penthrox (maximum de 2X3ml initial et au maximum 3mlX5 par semaine).

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OBJECTIVES:

Methoxyflurane is an inhalation analgesic used in the emergency department (ED) but also has minimal sedative properties. The major aim of this study was to evaluate the success rate of methoxyflurane for acute anterior shoulder dislocation (ASD) reduction. The secondary aim was to assess the impact of methoxyflurane on ED patient flow compared to propofol.

METHODS:

A health record review was performed for all patients presenting with ASD who underwent reduction with either methoxyflurane or propofol over a 13-month period (December 2016 - December 2017). The primary outcome was reduction success for methoxyflurane, while secondary outcomes such as recovery time and ED length of stay (LOS) were also assessed compared to propofol. Patients with fracture dislocations, polytrauma, intravenous, or intramuscular opioids in the pre-hospital setting, no sedation for reduction, and alternative techniques of sedation or analgesia for reduction were excluded.

RESULTS:

A total of 151 patients presented with ASD during the study period. Eighty-two patients fulfilled our inclusion criteria. Fifty-two patients had ASD reduction with propofol while 30 patients had methoxyflurane. Successful reduction was achieved in 80% (95% CI 65.69% to 94.31%) patients who used methoxyflurane. The median recovery time and ED LOS were 30 minutes [19.3-44] and 70.5 minutes [49.3-105], which was found to be shorter for the methoxyflurane group, who had successful reductions compared to sedation with propofol.

CONCLUSION:

Methoxyflurane was used successfully in 30% of the 82 patients undergoing reduction for ASD, while potentially improving ED efficiency.