Analgesic Effectiveness and Improvement in Quality of Life after Using Topical Sevoflurane for an Extremely Painful Anal Fissure

Abstract

Painful anal fissures could be distressing conditions that severely impair the patients' quality of life. The analgesic effectiveness of topical drugs, such as calcium-antagonists and nitrates is quite variable. The inhalational anesthetic sevoflurane is being repurposed as a topical analgesic for painful chronic wounds. We report a pioneer experience treating a painful chronic anal fissure with topical sevoflurane. A young adult male was suffering from an extremely painful chronic anal fissure, which severely affected his quality of life. The topical treatment with nitroglycerine and diltiazem gels failed. The patient agreed to the treatement with topical sevoflurane as an off-label medication, and it produced an immediate, intense, and long-lasting analgesic effect. An intense but rapidly transient burning sensation, as well as persistent but well-tolerated flatulence were the only adverse effects. The quality of life was greatly improved, and the cost of the treatment was affordable. Therefore, the off-label use of topical sevoflurane appears to be an effective alternative for the symptomatic treatment of painful anal fissures.

Clinical and histological safety assessment of repeated intra-articular sevoflurane injections into knee joints of Sprague-Dawley rats

“…35 Furthermore, sevoflurane has recently been reported as an analgesic for treating painful conditions affecting rectal and urethral mucosae, specifically a postoperative urethritis 36 and an anal fissure. 37 The patient with urethritis received only one dose of sevoflurane, which was insufficient to conclusively establish safety. However, the patient suffering from a painful anal fissure was successfully treated with repeated doses of 3 mL sevoflurane, presenting no indication of mucosal damage; importantly, the fissure reportedly healed.…”

“…This is consistent with the lack of systemic effects observed after topical sevoflurane application to chronic wounds 18 and when injected into body cavities. 19,20,36,37 It has been proposed that, as for any other drug applied topically, sevoflurane will enter the venous system, where it can subsequently reach alveolar capillaries. Owing to its volatility, it diffuses into the alveoli and is exhaled through respiration.…”