The use of liquid sevoflurane on sites infected by microorganisms resistant to conventional antibiotics appears to be an attractive therapeutic option that deserves future research.
SummaryWe are presenting the case of a patient with a very painful venous ulcer for whom therapy with different analgesic combinations (including acetaminophen, metamizol, tramadol, morphine, fentanyl, buprenorphine, pregabal-in, gabapentin, as well as applications of lido-caine/prilocaine eutectic cream and infusion of epidural ropivacaine) was unsatisfactory. Analgesic control was finally achieved through applications of liquid sevoflurane to the wound, which resulted in immediate, intense, and long-lasting analgesia. To the patients satisfaction, the same response was obtained throughout the 16 days it took the ulcer to heal. The compassionate use of sevoflurane in this innovative and promising manner warrants further research to evaluate its efficacy and safety.
that topical application of sevoflurane to painful wounds produced a rapid, robust, and long-lasting analgesic effect that allowed a high degree of wound debridement. The authors should be applauded for performing a well-designed study of an important topic (acute pain) in patients undergoing wound debridement. 2,3 The need to reduce costs by using simple methods makes the topic very important in perioperative medicine. 4,5 Nonetheless, there are some critical points that need to be clarified to determine the validity of the authors' findings. First, it is unclear how the authors could determine effectiveness if their study did not have a control group. Second, the authors reported that patients received usual care with other analgesics, but they did not control for the expected analgesic response due to the use of other analgesics. It is possible that the effectiveness of topical sevoflurane was caused by the concomitant use of other analgesics. Furthermore, patients were asked to estimate the total duration of analgesia, but this was not defined, which is important as patients were not pain free before the procedure (the baseline median pain score was 7). Last, as a comment on the safe use of sevoflurane, the authors did not mention any exclusion criteria in their selection of patients. Before the use of volatile anesthetics, a screening for family or personal history of malignant hyperthermia should be performed, and use of these agents should be avoided in such cases. I would welcome comments to address the aforementioned issues as they were not discussed by the authors. This would help to further substantiate the findings of this important study.
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