Two systematic reviews were identified regarding the use of inhaled methoxyflurane as an analgesia for pain in the pre-hospital setting; however, neither of the systematic reviews provided a summary statistic, thus it is difficult to determine the magnitude of benefits of this agent in this particular population. Two primary studies were identified, both of which were retrospective observational studies. One was a safety study and inhaled methoxyflurane appeared to be safe and well tolerated. The other study suggested it was less effective for pain relief in this setting when compared to intravenous morphine or intranasal fentanyl.No relevant cost-effectiveness studies or evidence-based guidelines were identified for the use of methoxyflurane for the management of moderate to severe pain associated with acute trauma and/or procedureal pain in pre-hospital setting; therefore, no conclusions can be made. Given the limited availability and low quality of evidence, the effectiveness and use of inhaled methoxyflurane in the pre-hospital setting remains uncertain.