PPF78 Case report: the use of penthrox for the management of severe incident pain in the hospice setting

<h3>Introduction</h3> Penthrox is a fast-acting, environmentally-friendly inhaler device that administers the analgesic methoxyflurane. It was licensed in the UK in 2015 for emergency relief of moderate to severe pain in conscious adults with trauma. It has since gained traction for use off-license in other settings such as elective procedures and has potential to benefit patients in palliative care, though research in this area is limited. Here we present a case in which Penthrox was implemented in the hospice setting to manage otherwise uncontrolled incident pain. <h3>Case Presentation</h3> A 54-year-old man was admitted for symptom control following a diagnosis of lung adenocarcinoma with cerebral and bone metastases. He had severe pain, in part secondary to bony disease, but also due to a large mass in the left side of his pelvis which was abutting and displacing the sciatic nerve. During admission he also sustained a pathological humeral fracture. Pain was significantly exacerbated by movement, which became a source of anxiety for him. <h3>Management</h3> During admission, his oxycodone was uptitrated substantially. He was trialled on naproxen, celecoxib, methadone and fentanyl but with little effect, thus these were discontinued. He also underwent a nerve block and received palliative radiotherapy in an effort to control pain. Whilst oxycodone and midazolam offered some relief, he still experienced severe incident pain during personal care. He was then offered Penthrox which was extremely effective, enabling him to remain comfortable during care which was previously intolerable. Subsequently, a decision was made to use it off-license for one episode of care each day. <h3>Conclusion</h3> This case demonstrates the benefit of Penthrox in managing otherwise insurmountable incident pain in palliative care. Although it is patient-controlled and offers increased autonomy, there are potential obstacles to its wider implementation in hospice settings, such as availability and off-license use.