PT  - JOURNAL ARTICLE
AU  - F Dámaso Fernández-Ginés
AU  - Manuel Cortiñas-Sáenz
AU  - Carmen Selva-Sevilla
AU  - Manuel Gerónimo-Pardo
TI  - Sevoflurane topical analgesia for intractable pain with suicidal ideation
AID  - 10.1136/bmjspcare-2019-002023
DP  - 2020 Jun 29
TA  - BMJ Supportive & Palliative Care
PG  - bmjspcare-2019-002023
4099  - http://spcare.bmj.com/content/early/2020/06/28/bmjspcare-2019-002023.short
4100  - http://spcare.bmj.com/content/early/2020/06/28/bmjspcare-2019-002023.full
AB  - 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.