Aims and Objectives Methoxyflurane (Penthrox) is a volatile anaesthetic which has analgesic properties at low doses. It has been commonly used in adults for procedural analgesia in the UK since it was licensed in 2015, however it is not currently licensed in the paediatric population despite common use in this population in Australia and New Zealand.

The objective of this quality improvement project was to introduce Penthrox into a busy paediatric emergency department, providing quick and effective analgesia to facilitate procedures in the department for patients over 5 years of age. The aim was to provide Penthrox as an alternative to esketamine sedation, assess patient journey and experience, acceptability of use, safety and side effect profile.

Method and Design The use of off-licence methoxyflurane (Penthrox) was introduced to the paediatric emergency department for acute traumatic pain as a possible alternative to esketamine sedation. A departmental training programme was provided to all staff members who were involved in prescribing or administering Penthrox to patients.

A data collection form was introduced to collect all relevant information including the indication for use, a safety checklist, side effects, need for other analgesia and the alternative pathway for the patient if Penthrox had not been available.

All penthrox use was audited from 6.3.24 to 6.6.24.

Results and Conclusion 62 patients received Penthrox during the audit period, data collection was complete for 48 patients.

There were 6 esketamine sedations during the audit period compared with 29 in the same period in 2023.

Procedures, mostly fracture manipulations, were well tolerated under Penthrox (83%, 40/48)

Penthrox is easy to use in this patient population, with adequate technique by most patients (98%, 47/48)

Introduction of Penthrox has significantly reduced esketamine sedations within the Emergency Department. It is well tolerated and safe to use in the paediatric emergency department.