Pharmacy, Torrecárdenas Hospital Complex, Almeria, Andalucía, Spain.
Unit of Pain - Anesthesiology, Torrecárdenas Hospital Complex, Almeria, Andalucía, Spain.
BMJ Support Palliat Care. 2022 Jul;12(e2):e192-e193. doi: 10.1136/bmjspcare-2019-002023. Epub 2020 Jun 29.
Proper symptom management to improve quality of dying is mandatory in palliative care patients. Home-based control of pain caused by leg ulcers is challenging, especially when the pain is severe and refractory to conventional analgesics, the patient is intolerant to opioids and refuses invasive measures. This was the case for an 87-year-old woman under oncological palliative care who suffered from a leg ulcer causing refractory pain, which produced suicidal ideation. Leg amputation was indicated, but she had signed a living will refusing any invasive measures. After obtaining written informed consent, sevoflurane was applied topically on the ulcer, which resulted in a rapid and long-lasting reduction of pain. Daily self-administration of sevoflurane successfully controlled the wound pain and the patient abandoned her suicidal ideation, the wound healed 35 days later, and her quality of dying improved remarkably. Topical sevoflurane deserves further research on ulcers of vascular and also neoplastic aetiology.
在姑息治疗患者中，必须进行适当的症状管理以提高临终质量。居家控制由腿部溃疡引起的疼痛具有挑战性，尤其是在疼痛剧烈且对常规镇痛药有抗药性、患者对阿片类药物不耐受并拒绝侵入性措施的情况下。这是一位 87 岁接受肿瘤姑息治疗的女性患者的情况，她患有腿部溃疡引起的难治性疼痛，导致自杀意念。需要进行截肢，但她签署了生前预嘱，拒绝任何侵入性措施。在获得书面知情同意后，将七氟醚局部应用于溃疡处，疼痛迅速而持久地减轻。每天自行使用七氟醚成功控制了伤口疼痛，患者放弃了自杀念头，35 天后伤口愈合，临终质量显著改善。局部七氟醚值得进一步研究血管性和肿瘤性病因的溃疡。
