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.

Topical sevoflurane and healing of a post-operative surgical site superinfected by multi-drug-resistant Pseudomonas aeruginosa and susceptible Staphylococcus aureus in an immunocompromised patient.

BACKGROUND: Infections caused by multi-drug-resistant organisms are too common and represent a therapeutic challenge. Topical application of sevoflurane may be useful for the treatment of cutaneous infections, as this general anesthetic has antimicrobial properties in vitro. CASE REPORT: A 43-year-old male patient received a liver transplant because of cirrhosis caused by hepatitis C. The surgical site was infected initially by multi-drug-resistant Pseudomonas aeruginosa that was susceptible to colistin, but parenteral administration of this antibiotic led to deterioration of renal function and was discontinued. The incision did not heal with daily lavage and debridement and was superinfected with Staphylococcus aureus. The off-label use of liquid sevoflurane in the form of site irrigations was followed by healing and closure of the site. This healing could be attributable to the mixed effect of three possible actions of sevoflurane: Direct antimicrobial effect, local analgesic effect that improved the quality of the dressings, and a direct vasodilator effect that, in theory, increased the supply of nutrients to the incision bed. CONCLUSIONS: The use of liquid sevoflurane on sites infected by microorganisms resistant to conventional antibiotics appears to be an attractive therapeutic option that deserves future research.