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.
- leg ulcer
- pain, intractable
- self administration
- home care services, hospital-based
- palliative care
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Contributors MC-S was the physician in charge of the patient. He wrote the first draft focusing on clinical aspects and approved the final version. DF-G provided sevoflurane to the patient and controlled its proper administration, collaborated with subsequent drafts and approved the final version. CS-S elaborated mainly on the economic aspects of the clinical case and approved the final version. MG-P was mainly responsible for second and subsequent drafts and approved the final version.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests MG-P has acted as a consultant for Vapogenix Inc and owns stock options.
Patient consent for publication Parental/guardian consent obtained.
Ethics approval This patient gave written informed consent to be treated with topical sevoflurane following the Therapeutic Protocol “Estudio observacional prospectivo para evaluar la utilización de un protocolo con Sevoflurano tópico como uso “Off Label” en pacientes con úlceras vasculares crónicas”, which was approved by our Institutional Review Board on October 30th, 2013 (Code CFF-SEV-2013-01). The patient died by the time we decided to send her case for publication and we were unable to contact her relative obtained on 3 July 2019 (Code 93/2019). After that, we had another attempt to contact any relatives by the patient’s attending physician.
Provenance and peer review Not commissioned; internally peer reviewed.