Eficacia analgésica del sevoflurano tópico en heridas

espanolEl sevoflurano es un anestesico derivado halogenado del eter dietilico que se presenta como un liquido volatil. Es ampliamente utilizado por via inhalatoria para la induccion y el mantenimiento de la anestesia general, pues su perfil de seguridad es muy bueno. Ademas de su accion hipnotica, diversas experiencias preclinicas muestran que el sevoflurano y otros derivados halogenados del eter producen un efecto analgesico/anestesico importante cuando son administrados en su formulacion liquida directamente al sistema nervioso central, concretamente a la medula espinal, pero clasicamente se les considera carentes de efecto analgesico a nivel periferico. Sin embargo, en los ultimos anos se estan comunicando experiencias clinicas en las que el sevoflurano produce un efecto analgesico importante sobre heridas dolorosas cuando es irrigado en su presentacion liquida sobre el lecho de dichas heridas. Este efecto analgesico se caracteriza por instaurarse en escasos minutos, ser lo bastante intenso como para permitir el desbridamiento mecanico de las heridas, y extenderse por espacio de varias horas. Referido a efectos adversos, hasta ahora no ha sido comunicado ninguno a nivel sistemico, y el efecto local mas frecuentemente referido por los pacientes es prurito leve y transitorio. Hasta ahora las comunicaciones clinicas se limitan a casos clinicos aislados y series de casos, y es obvio que se precisa la realizacion de los pertinentes ensayos clinicos para establecer adecuadamente su papel en el tratamiento analgesico de las heridas dolorosas. Pero mientras estos ensayos clinicos se realizan, el empleo fuera de indicacion de sevoflurano irrigado topicamente sobre el lecho de heridas dolorosas es una alternativa analgesica de rescate a tener en cuenta en aquellas heridas de dolor refractario a los tratamientos habituales. EnglishSevoflurane is a halogenated anesthetic derived from diethyl ether, which is presented as a volatile liquid. Administered by inhalation, it is widely used for the induction and maintenance of general anesthesia, as its safety profile is very good. In addition to their hypnotic action, various preclinical experiences show that sevoflurane and other halogenated ether derivatives produce an important analgesic/anesthetic effect when administered in their liquid form directly to the central nervous system, specifically to the spinal cord. However, it is classically thought they lack analgesic effect at peripheral level. However, clinical experiences in which sevoflurane had an important analgesic effect on painful wounds when it was irrigated in its liquid presentation on the bed of such wounds have been reported in recent years. Such analgesic effect is characterized by being established in a few minutes, be intense enough to allow sharp debridement of the wounds, and last for several hours. Concerning adverse effects, it has been reported so far no case of systemic adverse events; only local adverse effects have been reported, the most frequently reported one being mild and transitory itching. For the moment, clinical communications are limited to isolated clinical cases and case series of patients; obviously, relevant clinical trials are required to adequately establish the role of topical sevoflurane in the analgesic treatment of painful wounds. But while conducting these clinical trials, the off-label use of topical sevoflurane irrigated on the bed of painful wounds may be an alternative option for the analgesic treatment of wounds with pain refractory to usual treatments.