Whistle While You Writhe
We need the Green Whistle!
I first heard about the Green Whistle from my Australian friend Dr. Fiona Mack.
We talked about it in the context of IUD insertion, a procedure that many women find intimidating and painful. She did not realize we do not have it here in Israel or in the United States. She explained that the green whistle can help women manage this discomfort.
Little did I know that a year later I would end up using the green whistle myself. I broke my wrist in Ireland, and the bones needed to be realigned. I knew it would hurt like crazy, so I asked for the whistle (how did I even remember it?). The doctor said, “You want the whistle? Sure.”
They handed it to me and I could not believe I was holding the coveted instrument. I had been advocating for it for so long. I foolishly thought it would actually look like the whistles we used to play with but it was slightly more sophisticated. They assumed I knew how to use it 😵💫. My partner said I appeared to be screaming during the procedure, without sound. I recall nothing. When people asked if they did a reduction, repositioning of the bones to the normal position after a fracture, I initially said no. I had no memory of it.
What is the Green Whistle?
The green whistle is a small, portable inhaler containing methoxyflurane, a volatile liquid with a fruity smell. Methoxyflurane was initially used as a general anesthetic in the 1960s but was later repurposed for pain relief due to its effectiveness and ease of use in smaller doses. Made in Melbourne, Penthrox, the brand name, has been used in Australia for decades, where it is nicknamed the green whistle. It is approved in Australia, New Zealand, Ireland and other European countries. In clinical trials it reduced pain more rapidly and to a greater extent than laughing gas and other IV analgesics.
Methoxyflurane has been banned in the United States since 2005 because of a slightly greater number of cases of nephrotoxicity and hepatotoxicity. This data has not been replicated in current studies at the doses that are given today.
For many women, the idea of getting an intrauterine device (IUD) inserted or removed can be daunting due to the potential for pain and discomfort. The green whistle has emerged as a useful tool to help manage this pain, making the process more bearable.
How Does It Work?
When you inhale through the green whistle, the methoxyflurane vaporizes and is absorbed through the lungs, providing pain relief within minutes. The inhaler allows patients to self-administer the medication, giving them control over their pain management and a built-in safety feature wherein the user will stop getting dosed as soon as they are too sleepy. Each dose lasts about 30 minutes making it ideal for short-term pain relief in emergency settings.
Benefits of the Green Whistle
FAST-ACTING: Pain relief can be felt almost immediately after a few deep breaths. Ideal for the short duration of IUD procedures.
EASY TO USE: The design is simple, allowing patients to self-medicate as needed.
PORTABLE: Unlike intravenous pain relief methods, the green whistle doesn't require additional equipment, making it highly portable and easy to use in various settings like mountain, military and surf rescues.
NON-OPIOID: Methoxyflurane is a non-opioid analgesic, reducing the risk of addiction and making it a safer alternative to traditional painkillers like morphine.
NON-INVASIVE: The green whistle is non-invasive compared to injectable pain relief methods, which can be more cumbersome and anxiety-inducing for patients.
SUSTAINABLE: Penthrox was more sustainable in terms of environmental impact compared to nitrous oxide.
Clinical Support
Studies have shown that methoxyflurane is effective in providing pain relief for various medical procedures, including minor surgeries and trauma treatments (Lincoln News) (BioMed Central). Its application in gynecological procedures like IUD insertion and removal is gaining traction due to its ease of use and rapid onset of action.
A study published in BMC Emergency Medicine highlighted methoxyflurane's safety and effectiveness in emergency settings, underscoring its potential in gynecological procedures as well (BioMed Central).
Safety
While the green whistle is generally safe, it's important for it to be used under the guidance of a healthcare professional. High doses can potentially cause liver and kidney damage. Therefore, it is crucial to adhere to recommended dosage.
Patients with certain health conditions, such as significant liver or kidney disease, may need alternative pain management strategies.
Bottom Line
Science is a relentless force, ever-evolving and reshaping our understanding of the world. As dedicated clinicians and researchers, it is imperative that we not only stay abreast of these changes but also fuel our insatiable curiosity. We cannot afford to let old studies fade into obscurity; instead, we must scrutinize them, draw wisdom from international advancements, and relentlessly pursue innovation.
The green whistle is not just a tool; it's a symbol of our commitment to this relentless pursuit of knowledge and commitment to our patients.
While I did spend too much time in Irish hospitals, the experiences were fascinating. In my opinion, you can't truly understand a country until you've visited their emergency room.
Cheers to the green whistle,
Dr. Annie K. 😗
Thanks Anne for the info. Never heard of the green whistle so now I know. Hoping I won’t have to use it on my trip while in Europe. 😊
You might recall i fell off my bike and broke my arm in Spain. My experience in a small Spanish hospital in the middle of the country was actually a highlight of the trip. No frills, no food, no constant monitoring like in US hospitals, but excellent doctors. Google translate was very helpful. And it cost a tenth of what it would have cost at home. Hooray for hospital tourism!