{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T20:10:34Z","timestamp":1791231034357,"version":"4.1.0"},"reference-count":58,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2024,9,26]],"date-time":"2024-09-26T00:00:00Z","timestamp":1727308800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Acta Anaesthesiol Scand"],"published-print":{"date-parts":[[2024,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Many prehospital emergency patients receive suboptimal treatment for their moderate to severe pain. Various factors may contribute. We aim to systematically review literature pertaining to prehospital emergency adult patients with acute pain and the pain\u2010reducing effects, adverse events (AEs), and safety issues associated with inhaled analgetic agents compared with other prehospital analgesic agents.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>As part of an initiative from the Scandinavian Society of Anaesthesia and Intensive Care Medicine, we conducted a systematic review (PROSPERO CRD42018114399), applying the PRISMA guidelines, Grading of Recommendations Assessment, Development, and Evaluation (GRADE), and Cochrane methods, searching the Cochrane Library, Epistemonikos, Centre for Reviews and Dissemination, PubMed, and EMBASE databases (updated March 2024). Inclusion criteria were the use of inhaled analgesic agents in adult patients with acute pain in the prehospital emergency care setting. All steps were performed by minimum of two individual researchers. The primary outcome was pain reduction; secondary outcomes were speed of onset, duration of effect, and relevant AEs.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>We included seven studies (56,535 patients in total) that compared inhaled agents (methoxyflurane [MF] and nitrous oxide [N<jats:sub>2<\/jats:sub>O]) to other drugs or placebo. Study designs were randomized controlled trial (1; <jats:italic>n<\/jats:italic>\u2009=\u200960), randomized non\u2010blinded study (1; <jats:italic>n<\/jats:italic>\u2009=\u2009343), and randomized open\u2010label study (1; <jats:italic>n<\/jats:italic>\u2009=\u2009270). The remaining were prospective or retrospective observational studies. The evidence according to GRADE was of low or very low quality. No combined meta\u2010analysis was possible. N<jats:sub>2<\/jats:sub>O may reduce pain compared to placebo, but not compared to intravenous (IV) paracetamol, and may be less effective compared to morphine and MF. MF may reduce pain compared to paracetamol, ketoprofen, tramadol, and fentanyl. Both agents may be associated with marked but primarily mild AEs.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>We found low\u2010quality evidence suggesting that both MF and N<jats:sub>2<\/jats:sub>O are safe and may have a role in the management of pain in the prehospital setting. There is low\u2010quality evidence to support MF as a short\u2010acting single analgesic or as a bridge to IV access and the administration of other analgesics. There may be occupational health issues regarding the prehospital use of N<jats:sub>2<\/jats:sub>O.<\/jats:p><\/jats:sec>","DOI":"10.1111\/aas.14527","type":"journal-article","created":{"date-parts":[[2024,9,27]],"date-time":"2024-09-27T03:53:57Z","timestamp":1727409237000},"page":"1306-1318","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Inhaled analgesics for the treatment of prehospital acute pain\u2014A systematic review"],"prefix":"10.1111","volume":"68","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2480-8528","authenticated-orcid":false,"given":"Per Kristian","family":"Hyldmo","sequence":"first","affiliation":[{"name":"Division of Prehospital Care S\u00f8rlandet Hospital Trust  Kristiansand Norway"},{"name":"Faculty of Health Sciences University of Stavanger  Stavanger 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