Pain management & opioid dose reduction with topical sevoflurane instillations in intractable venous ulcers
a case report
DOI:
https://doi.org/10.1590/s2175-97902020000318681Keywords:
Pain, vascular ulcer, Topical drug administration, Opioids, SevofluraneAbstract
Vascular ulcers (VU) constitute a major cause of pain and disability, and significantly compromise quality of life. VU have a natural tendency to become chronic and in many cases exhibit anunsatisfactoryresponse to many of the standard therapeutic options.The case of a 73 year-old Caucasian female with severe pain and poorly-controlled pain (Visual Analogic Scale-VAS- of 8-9) due to three lower leg long-standing VUs is reported and discussed herein. The patient was treated with topical instillations of undiluted sevoflurane as per institutional off-label protocol (starting doses of 1mL/cm2 twice a day, and up-titrated according to response to a maximum of 7 mL twice daily). The VAS score dropped to 0-1 shortly after initiation of therapy and remained stable throughout treatment up until the closure of the observations. Subsequently, opioid therapy was gradually tapered down and ultimately abandoned. Sevoflurane application resulted on adequate and sustained pain management of refractory VU, with no significant side effects. On account of its beneficial effectivity and safety profiles, topical sevoflurane emerges as an add-on alternative for the long-term management of VU, and potentially other painful conditions.
Downloads
References
Nelson EA, Adderley U. Venous leg ulcers. BMJ Clin Evid. 2016;2016:1902.
Argoff CE. Topical analgesics in the management of acute and chronic pain. MayoClinProc. 2013;88(2):195-205.
Briggs M, Nelson EA, Martyn-St James M. Topical agents or dressings for pain in venous leg ulcers. Cochrane database of systematic reviews.2012;11.CD001177
Chu CC, Wu SZ, Su WL, Shieh JP, kao CH, Ho ST, Wang JJ. Subcutaneous injection of inhaled anesthetics produces cutaneous analgesia. Can J Anaesth. 2008; 55(5):290-294.
Fernández-Ginés FD, Cortiñas-Sáenz M, Mateo-Carrasco H, de Aranda AN, Navarro-Muñoz E et al. Efficacy and safety of topical sevoflurane in the treatment of chronic skin ulcers. Am J Eur J Hosp Pharm. 2018; 26(4):229-232.
Fernández-Ginés FD, Cortiñas-Sáenz M, Navajas-Gómez de Aranda A, Maria del Carmen Navas-Martinez, José Antonio Morales-Molina et al. Palliative analgesia with topical sevoflurane in cancer-related skin ulcers: a case report. Eur J Hosp Pharm.2018;0:1-4.
Fitzpatrik TB, Bernhard JD, Cropley TG. The structure of skin lesions and fundamentals of diagnosis. Fitzpatrik’s dermatology in general medicine. New York: McGraw-Hill 1999. p.13-41.
Gerónimo M, Martínez A, Martínez M. Analgesic effect of topical sevoflurane on venous ulcer intractable pain. Phlebologie. 2011;40(2):95-97.
Gilman T. Parameter for measurement of wound closure. Wounds. 1990;2:95-101
Järbrink K, Ni G, Sönnergren H, Schmidtchen A, Pang C, Bajpai R, Car1 J. Prevalence and incidence of chronic wounds and related complications: a protocol for a systematic review. Syst Rev. 2016;5(1):152.
Kundin JL. Designing and developing a new measuring instrument. PerioperNurs Q. 1985;8(4):37-42.
Herber OR, Schnepp W, Rieger MA. A systematic review on the impact of leg ulceration on patient’s quality of life. Health Qual Life Outcomes.2007;5(1):44
Imbernón-Moya A, Ortiz-de Frutos FJ, Sanjuan-Alvarez M, Portero-Sanchez I, Merinero-Palomares R, Alcazar V. Topical sevoflurane for chronic venous ulcers infected by multi-drug- resistant organisms. Int Wound J. 2017;14(6):1388-1390.
Martínez-Serrano M, Gerónimo-Pardo M, Martínez- Monsalve A, Crespo-Sánchez MD. Antibacterial effect of sevoflurane and isoflurane. RevEspQuimioter. 2017;30(2):84-89.
Martínez A, Gerónimo M. Sevoflurano como anestésico local en herida isquémica de paciente cardiópata con insuficiencia respiratoria secundaria a morfina. Heridas y cicatrización. 2011;6:46-9.
Preckel B, Bolten J. Pharmacology of modern volatile anaesthetics. BestPract Res Clin Anaesthesiol. 2005;19(3):331-48.
Rüger LJ, Irnich D, Abahji TN, Crispin A, Hoffman U, Lang PM. Characteristics of pain in patients with peripheral arterial disease. Pain. 2008;139(1):201-208.
Vowden P, Vowden K. The economic impact of hard-to-heal wounds: promoting practice change to address passivity in wound management. Wound Int, 2016;7(2):10-15
Downloads
Published
Issue
Section
License
Copyright (c) 2022 Brazilian Journal of Pharmaceutical Sciences
This work is licensed under a Creative Commons Attribution 4.0 International License.
All content of the journal, except where identified, is licensed under a Creative Commons attribution-type BY.
The on line journal has open and free access.
