Department of Dermatology, Hospital Severo Ochoa, Madrid, Spain.
Department of Dermatology, Hospital Doce de Octubre, Madrid, Spain.
J Vasc Surg. 2018 Sep;68(3):830-835. doi: 10.1016/j.jvs.2017.11.071. Epub 2018 Feb 13.
Pain in chronic venous ulcers (CVUs) notably increases with the usual cleaning of the wound. Chronic pain is usually poorly controlled even with the multiple analgesic treatments available. Analgesics can have different serious adverse effects and medical interactions in old patients with several comorbidities. This study reports the efficacy and safety of topical sevoflurane for treatment of pain in CVUs.
We report a descriptive and retrospective study of 30 patients older than 65 years with painful CVUs refractory to conventional analgesic treatments. Patients received topical sevoflurane treatment before the usual cleaning of the ulcer. Cleaning visits with sevoflurane every 2 days for a period of 1 month were scheduled. We compared the visual analog scale results and analgesic drugs for cleaning with and without topical sevoflurane. The systemic pharmacokinetics of sevoflurane after topical application has not been determined.
Pain related to CVUs decreased with topical sevoflurane. Sevoflurane had an analgesic effect with latency time between 2 and 7 minutes. The duration of analgesia ranged between 8 and 18 hours. The time needed to take an analgesic treatment increased after application of sevoflurane. The use of other conventional analgesic drugs, including paracetamol, metamizole, nonsteroidal anti-inflammatory drugs, tramadol, and major opioids, was progressively reduced. The main local adverse effects were mild and transient, including heat, pruritus, and erythema. There were no systemic adverse effects.
Topical sevoflurane has an intense, fast, and long-lasting local analgesic effect with an adequate safety profile. It also diminishes the taking of other conventional analgesic drugs. Topical sevoflurane is an efficient and safe therapeutic alternative for refractory painful CVUs.
慢性静脉溃疡（CVU）的疼痛会随着伤口的常规清洁而显著增加。即使有多种可用的镇痛治疗方法，慢性疼痛通常也控制不佳。对于患有多种合并症的老年患者，镇痛药可能会产生不同的严重不良反应和药物相互作用。本研究报告了局部七氟醚治疗 CVU 疼痛的疗效和安全性。
我们报告了一项针对 30 名年龄大于 65 岁的有疼痛性 CVU 且对常规镇痛治疗无反应的患者的描述性和回顾性研究。患者在常规清洁溃疡前接受局部七氟醚治疗。计划每 2 天清洁一次，同时使用七氟醚，为期 1 个月。我们比较了使用和不使用局部七氟醚清洁时的视觉模拟量表（VAS）评分和镇痛药结果。尚未确定局部应用七氟醚后的全身药代动力学。
CVU 相关疼痛在使用局部七氟醚后减轻。七氟醚有镇痛作用，潜伏期为 2-7 分钟。镇痛持续时间为 8-18 小时。使用七氟醚后，需要服用镇痛药的时间增加。其他常规镇痛药的使用，包括对乙酰氨基酚、甲灭酸、非甾体抗炎药、曲马多和主要阿片类药物，逐渐减少。主要局部不良反应为轻度且短暂，包括发热、瘙痒和红斑。没有全身不良反应。
局部七氟醚具有强烈、快速和持久的局部镇痛作用，安全性良好。它还减少了其他常规镇痛药的使用。局部七氟醚是治疗难治性疼痛性 CVU 的有效且安全的治疗选择。
