Sevoflurano tópico: una nueva opción terapéutica paliativa en las úlceras cutáneas

Chronic outpatient treatment with topical sevoflurane in patients with vascular ulcers

OBJECTIVE

To show the effectiveness and safety of topical sevoflurane after ambulatory and prolonged administration in patients with refractory vascular ulcers.

METHODS

Retrospective observational study analyzing clinical improvement and vascular ulcers surface area variation after topical application of sevoflurane. Inclusion criteria were patients with painful vascular ulcers refractory to usual therapies and who were treated with topical sevoflurane for at least 36 months. The following variables were collected: age, sex, medical history, associated comorbidity, ulcer etiology and medical treatment. The visual analog scale was used to measure baseline and break through pain intensity before and after treatment.

RESULTS

Nine patients met the inclusion criteria of the total number of patients treated whose median age was 74.8 ± 7.5 years. Cases 2 and 9 died during follow-up. In all cases, the analgesic action of topical sevoflurane was rapid (3.1 ± 2.1 minutes), intense (visual analog scale: 7 ± 1.1 to 1.4 ± 1.1 points) and long-lasting (6 to 24 h). With the exception of case 4, all patients experienced a large reduction in vascular ulcers surface area (15.1 ± 5.0 a 2.7 ± 4.2) and tolerance was not observed over time.

CONCLUSION

Topical application of sevoflurane is an analgesic and re-epithelializing strategy for vascular ulcers with a successful safety profile.

[Translated article] Chronic outpatient treatment with topical sevoflurane in patients with vascular ulcers

OBJECTIVE

To show the effectiveness and safety of topical sevoflurane after ambulatory and prolonged administration in patients with refractory vascular ulcers .

METHODS

Retrospective observational study analysing clinical improvement and vascular ulcers surface area variation after topical application of sevoflurane. Inclusion criteria were patients with painful vascular ulcers refractory to usual therapies and who were treated with topical sevoflurane for at least 36 months. The following variables were collected: age, sex, medical history, associated comorbidity, ulcer aetiology, and medical treatment. The visual analogue scale was used to measure baseline and break through pain intensity before and after treatment.

RESULTS

Nine patients met the inclusion criteria of the total number of patients treated whose median age was 74.8±7.5 years. Cases 2 and 9 died during follow-up. In all cases, the analgesic action of topical sevoflurane was rapid (3.1±2.1 min), intense (visual analogic scale: 7±1.1 to 1.4 ± 1.1 points), and long-lasting (6-24 h). With the exception of case 4, all patients experienced a large reduction in vascular ulcers surface area (15.1±5.0 to 2.7±4.2) and tolerance wasn't observed over time.

CONCLUSION

Topical application of sevoflurane is an analgesic and re-epithelialising strategy for vascular ulcers with a successful safety profile.

Analgesic effectiveness of topical sevoflurane to perform sharp debridement of painful wounds

OBJECTIVE

Analgesic topical options to perform wound debridement are scarce. The purpose of this study was to communicate our experience using topical sevoflurane as analgesic for wound debridement.

METHODS

After approval by our institutional review board, medical records were reviewed for those patients who had previously accepted to be treated with off-label topical sevoflurane (1 mL/cm²) as an analgesic for sharp debridement of painful wounds, because it was previously approved by our institutional Pharmacy Regulatory Commission and Medical Management. According to this protocol, pain scores were measured by using a numerical rating scale (from 0 to 10 points) over a 10-hour period. Wound debridement was performed following routine procedures.

RESULTS

Medical records from 152 patients were reviewed. Baseline pain was severe (median, 7 points). After topical sevoflurane application, the analgesic effect was rapid (median pain score of 2 points at 5 minutes), and full debridement was feasible in most wounds (93%). The initial intense analgesic effect lasted for 30 minutes and then it subsided gradually over time to nearly reach baseline values after 10 hours. The patients estimated that the analgesic effect lasted several hours (median, 9 hours), and their overall satisfaction was high (median of 8 points on a scale ranging from 0 to 10). Fifty-two patients (34%) experienced itching.

CONCLUSIONS

Topical application of sevoflurane to painful wounds produced a rapid, robust, and long-lasting analgesic effect, which allowed for a high degree of wound debridement.

Palliative analgesia with topical sevoflurane in cancer-related skin ulcers: a case report

A Caucasian 39-year-old male patient with a poorly-differentiated infiltrating epidermoid penile carcinoma with urethral invasion was diagnosed. The patient received concomitant adjuvant chemotherapy with radiotherapy in the palliative setting, which produced painful ulceration of tumour lesions at loco-regional level (Numerical Rate Scale, NRS=9). The patient consented for treatment with direct topical sevoflurane instillations, at initial doses of 1 mL/cm² of ulcerated area, as per unit protocol. The local use of undiluted sevoflurane achieved a marked reduction of the pain score in both nociceptive and irruptive pains (average NRS=3 immediately post-application). This improvement was corroborated by a decline in total morphine needs, any adverse events associated with major opiates. PGI-I and CGI-I scales were used before and after treatment with topical sevoflurane to assess patient and clinician perceptions of improvement in the quality of life. The pharmacy of our hospital had the responsibility to elaborate pre-loaded syringes with sevoflurane so that the patient was instilled simply and comfortably.