Nitrous oxide (N₂O), though widely used in procedural analgesia, is increasingly recognised for its environmental and occupational health risks. As healthcare networks strive toward sustainability and net zero emissions, identifying clinically effective, low-impact alternatives has become a priority. In alignment with this goal, the Sydney Children’s Hospitals Network initiated a pilot project exploring methoxyflurane as an alternative to nitrous oxide in the management of acute procedural pain in paediatric burn patients.
Methoxyflurane is a volatile, self-administered inhalational analgesic with a well-established safety profile in pre-hospital and emergency settings. While endorsed for adult burn care, limited data exists supporting its use in paediatric burn wound management. Our multidisciplinary team, led by an anaesthetic consultant and paediatric burns Nurse Practitioner, conducted a structured evaluation to determine the feasibility, safety, and efficacy of methoxyflurane during outpatient dressing changes.
The project included a comprehensive literature review, internal audit of current N₂O usage, stakeholder consultation, and a clinical gap analysis. Following this, clinical governance approval was secured, protocols developed, and targeted education delivered to clinical staff. Methoxyflurane was trialled in children aged ≥5 years undergoing dressing changes ≤30 minutes in duration. Patients were pre-assessed for anxiety and ability to follow instructions in collaboration with Child Life Therapy.
Preliminary findings indicate methoxyflurane is a safe, effective, and well-tolerated analgesic for selected paediatric burn patients. Importantly, its implementation led to a measurable reduction in N₂O usage, supporting our environmental sustainability objectives.
We will present data on patient outcomes, staff and caregiver feedback, and barriers to implementation. These findings support methoxyflurane’s broader adoption in paediatric burns care and contribute to evidence-based practice aligned with both clinical and environmental goals.