Cortiñas-Sáenz Manuel, Dámaso Fernández-Ginés F, Selva-Sevilla Carmen, Gerónimo-Pardo Manuel
Department of Anesthesiology, 16815Complejo Hospitalario Torrecárdenas, Almería, Spain.
Department of Anesthesiology, Hospital Universitario Virgen de las Nieves, Granada, Spain.
Int J Low Extrem Wounds. 2022 Jul 14:15347346221111418. doi: 10.1177/15347346221111418.
The general anesthetic sevoflurane is being repurposed as a topical analgesic for painful chronic wounds. This study was aimed to compare the analgesic effectiveness and safety of systemic analgesics alone or plus at-home topical sevoflurane for the management of patients with painful nonrevascularizable leg ulcers who were referred to a Pain Clinic by their attending vascular surgeons. We reviewed charts of patients treated in a single Pain Clinic with analgesic Standard of Care either alone (group SoC) or plus at-home topical sevoflurane (group SoC + Sevo), according to safety criteria. The area under the curve of pain over a year (AUC-Pain) was the primary outcome for analgesic effectiveness. Opioids were converted into Oral Morphine Milligram Equivalents. Groups SoC (n = 26) and SoC + Sevo (n = 38) were similar in baseline characteristics. Compared to SoC, median values [interquartile range] of area under the curve of pain for one-year follow-up were markedly lower for SoC + Sevo (54 [35-65] 15 [11-23]; p < 0.000001, U Mann-Whitney test). Oral Morphine Milligram Equivalents were similar at baseline (SoC: 78.5 [22.5-135] SoC + Sevo: 101.3 [30-160]; p = 0.753), but significantly lower for SoC + Sevo at three (120 [22.5-202.5] 30 [0-80]; p = 0.005), six (120 [11.3-160] vs. 20 [0-67.5]; p = 0.004), nine (114.4 [0-154] 0 [0-37]; p = 0.018), and 12 months (114.4 [0-154] 0 [0-20]; p = 0.001). Multiple linear regression analysis revealed the addition of sevoflurane to be the most likely variable to explain this difference in outcome (ß:-33.408; p < 0.000001). Nine patients (24%) in SoC + Sevo had adverse effects attributed to sevoflurane, but only one patient needed to stop using sevoflurane due severe dermatitis. In conclusion, the addition of topical sevoflurane to the analgesic standard of care in patients with painful nonrevascularizable leg ulcers was a well-tolerated therapy that significantly improved pain control and allowed for a significant reduction in opioid consumption.
全身麻醉药七氟醚正被重新用作治疗慢性疼痛伤口的局部镇痛药。本研究旨在比较单纯使用全身镇痛药或联合在家使用局部七氟醚对由血管外科主治医生转诊至疼痛门诊的疼痛性不可再血管化腿部溃疡患者的镇痛效果和安全性。我们根据安全标准，回顾了在单一疼痛门诊接受镇痛标准治疗的患者病历，这些患者分为单纯治疗组（SoC组）或联合在家使用局部七氟醚治疗组（SoC + Sevo组）。一年疼痛曲线下面积（AUC-疼痛）是镇痛效果的主要指标。将阿片类药物换算为口服吗啡毫克当量。SoC组（n = 26）和SoC + Sevo组（n = 38）的基线特征相似。与SoC组相比，SoC + Sevo组在一年随访期内疼痛曲线下面积的中位数[四分位间距]显著更低（54 [35 - 65] 对15 [11 - 23]；p < 0.000001，曼-惠特尼U检验）。口服吗啡毫克当量在基线时相似（SoC组：78.5 [22.5 - 135]，SoC + Sevo组：101.3 [30 - 160]；p = 0.753），但在3个月（120 [注：此处原文有误，应为SoC组120 [22.5 - 202.5]，SoC + Sevo组30 [0 - 80]；p = 0.005）、6个月（120 [11.3 - 160] 对20 [0 - 67.5]；p = 0.004）、9个月（114.4 [0 - 154] 对0 [0 - 37]；p = 0.018）和1年（114.4 [0 - 154] 对0 [0 - 20]；p = 0.001）时，SoC + Sevo组显著更低。多元线性回归分析显示，添加七氟醚是最有可能解释这一结果差异的变量（β：-33.408；p < 0.000001）。SoC + Sevo组有9名患者（24%）出现归因于七氟醚的不良反应，但只有1名患者因严重皮炎需要停止使用七氟醚。总之，对于疼痛性不可再血管化腿部溃疡患者，在镇痛标准治疗中添加局部七氟醚是一种耐受性良好的治疗方法，可显著改善疼痛控制，并大幅减少阿片类药物的使用量。
