Due to copyright issues, an electronic copy of the thesis must be ordered from the faculty. For the faculty to have time to process the order, the order must be received by the faculty at the latest 2 days before the public defence. Orders received later than 2 days before the defence will not be processed. After the public defence, please address any inquiries regarding the thesis to the candidate.
Order a digital copy of the thesis here
Trial Lecture – time and place
See Trial Lecture.
Adjudication committee
- First opponent: Professor Jacob Steinmetz, Aarhus University, Denmark
- Second opponent: Professor Jon-Kenneth Heltne, University of Bergen
- Third member and chair of the evaluation committee: Professor Signe Søvik, University of Oslo
Chair of the Defence
Professor Kjetil Sunde, University of Oslo
Principal Supervisor
Researcher Fridtjof Heyerdahl, University of Oslo
Summary
This thesis addresses pain management in ambulance services. It examines whether inhaled methoxyflurane and intranasal fentanyl provide effective, safe, and operationally feasible alternatives to intravenous morphine, and whether methoxyflurane can be implemented in routine clinical practice at an acceptable cost.
The thesis is based on three studies: A randomised controlled non-inferiority trial where 338 adult patients with acute moderate to severe pain were included and methoxyflurane, intranasal fentanyl, and intravenous morphine were compared; a cross-sectional survey combined with trial data where motivation among ambulance personnel, protocol deviations, and the feasibility of conducting a clinical drug trial in an ambulance service were examined; and a prospective observational study assessing the use of methoxyflurane in routine care, including treatment decisions, analgesic effect, adverse events, user satisfaction, and estimated drug costs.
Methoxyflurane was non-inferior to both intranasal fentanyl and intravenous morphine for pain reduction at ten minutes. Intranasal fentanyl did not meet the non-inferiority criterion when compared with intravenous morphine. No serious or unexpected adverse events occurred in the randomised trial. It is feasible to conduct a clinical randomised drug trial as part of routine ambulance work with ambulance personnell as study workers. Protocol adherence was challenging, but deviations decreased over time with support and follow-up from the study team. In routine practice, personnel primarily selected methoxyflurane when intravenous access was difficult, rapid treatment was important, or an alternative to opioids was preferred. This targeted use resulted in a modest increase in drug costs.
The findings show that non-intravenous analgesics can broaden the options for early and individualised prehospital pain management. Methoxyflurane might serve as a bridge to longer-lasting analgesics, and the increased costs will be modest with targeted use.
Additional information
Contact the research support staff.