Analgesic effect of topical sevoflurane on venous leg ulcer with intractable pain

Abstract

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.

Healing of chronic venous ulcer with topical sevoflurane

“…Our results show that topical sevoflurane have an epithelising effect, diminishing the time to healing. In previous reports, a progressive diminishing of size and deepness of the ulcer treated with sevoflurane in successive cleanings along some weeks has been reported .…”

“…Topical sevoflurane has an intense, quick and long‐lasting analgesic effect. The latency time varies between 1 and 10 minutes, and the duration ranges between 7 and 24 hours . Until now, we report the study with the highest number of patients with chronic venous ulcers treated with topical sevoflurane.…”

“…Sevoflurane is an inhaled halogenated anaesthetic agent with an adequate safety profile, used for induction and maintenance of general anaesthesia in hospital and ambulatory surgery . Its efficacy has been reported in a few case reports as a topical anaesthetic in leg ulcers . Our purpose is to assess the efficacy and safety of topical sevoflurane in CVU and its impact on analgesia and healing.…”

Chronic venous ulcer treatment with topical sevoflurane

“…Topical or subcutaneous sevoflurane has a reversible local and peripheral analgesic effect that has been clinically tested and is concentration-dependent, which is probably caused due to a sufficient partial pressure in the peripheral nociceptors that block the transmission of pain stimulus (6)(7)(8)(9). Topical sevoflurane has been reported in the literature as an analgesic treatment for vascular leg ulcers that are refractory to usual analgesics (1)(2)(3)(4)(5).…”

“…Geronimo-Pardo et al (2) reported the first case of a 76-year-old female with several risk factors of cardiovascular disease and bilateral painful venous ulcers that were treated with 5 ml of topical sevoflurane daily. An intense analgesic effect was reported in 2 minutes that lasted 12 hours.…”