Publication: Valoración del dolor, satisfacción, impacto en la calidad de vida y capacidad funcional con la administración de sevoflurano tópico previo a la curación de úlcera venosa crónica
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2018-11-28
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Universidad Complutense de Madrid
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Abstract
Las UVC constituyen una patología muy común con un gran impacto económico y epidemiológico, y con repercusión significativa en la calidad de vida del paciente. El ochenta y cinco por ciento de las úlceras crónicas de etiología mixta o venosa son dolorosas con un valor medio de EVA de 4,6 puntos (rango 1-10 puntos). El dolor crónico es la principal causa de discapacidad en la población adulta. El dolor generalmente causa trastornos del sueño, limitaciones de movilidad, cambios de humor, mayor dificultad para la cura, peor adherencia al tratamiento y problemas de cicatrización. Las UVC habitualmente crean dificultades en la relación entre pacientes y profesionales sanitarios. Las UVC por lo general producen dolor en reposo. El dolor aumenta con la limpieza, los desbridamientos quirúrgicos y los cambios de apósito. La puntuación EVA mayor o igual a 4 indica dolor significativo y mal controlado. Los pacientes requieren un enfoque terapéutico multidisciplinar. Un control analgésico apropiado es fundamental. Los tratamientos para el dolor más comúnmente utilizados son los analgésicos orales (antiinflamatorios no esteroideos, paracetamol, metamizol, tramadol, pregabalina, gabapentina y opioides) y cremas anestésicas tópicas como la lidocaína o la prilocaína. Estos fármacos pueden originar múltiples efectos adversos y complicaciones médicas secundarias dependiendo del medicamento utilizado y las características del paciente. El sevoflurano es un agente anestésico halogenado con un perfil de seguridad adecuado, utilizado mediante inhalación para la inducción y el mantenimiento de la anestesia general en la cirugía ambulatoria y hospitalaria. Se ha descrito su eficacia en escasos casos clínicos como un anestésico tópico en úlceras cutáneas de miembros inferiores. OBJETIVOS: Describir la eficacia y la seguridad del sevoflurano tópico como tratamiento del dolor en UVC. Evaluar su efecto analgésico, cicatrizante y antibacteriano. Analizar su impacto en los tratamientos analgésicos, la calidad de vida, la capacidad funcional y el gasto sanitario...
Chronic venous ulcers are a very common disease with high health expenditure and epidemiological impact, as well as a significant repercussion on patient’s quality of life. Eighty five percent of venous or mixed aetiology chronic ulcers are painful with a visual analog scale mean of 4.6 (range 1-10 points). Chronic pain is the leading cause of disability in the adult population. Pain usually causes sleep disturbances, mobility limitations, bad mood, greater difficulty in cleaning, worse adherence to treatment and impaired healing. Chronic venous ulcers usually create relationship problems between patients and sanitary professionals. Chronic venous ulcers usually induce severe pain at rest. Pain increases with cleanings, debridement and dressing changes. Visual analog scale punctuation greater than or equal to 4 indicates significant and poorly controlled pain. Patients require a multidisciplinary therapeutic approach. An appropriate analgesic control is essential. The most commonly therapeutic drugs are oral analgesics (non steroids antiinflamatory drugs, acetaminophen, metamizole, tramadol, pregabalin, gabapentin and opioids) and topical anaesthetic creams, such as lidocaine or prilocaine. These therapies may induce several adverse effects and complications depending on the drug used and the characteristics of the patient. Sevoflurane is an inhaled halogenated anaesthetic agent with an adequate safety profile, used for induction and maintenance of general anaesthesia in hospital and ambulatory surgery. Its efficacy has been reported in a few case reports as a topical anaesthetic in leg ulcers. OBJECTIVES: Report the efficacy and safety of topical sevoflurane as a treatment for pain in chronic venous ulcers. Assess its analgesic, healing and antibacterial effect. See its impact on analgesic drugs, quality of life, functional capacity and health expenditure...
Chronic venous ulcers are a very common disease with high health expenditure and epidemiological impact, as well as a significant repercussion on patient’s quality of life. Eighty five percent of venous or mixed aetiology chronic ulcers are painful with a visual analog scale mean of 4.6 (range 1-10 points). Chronic pain is the leading cause of disability in the adult population. Pain usually causes sleep disturbances, mobility limitations, bad mood, greater difficulty in cleaning, worse adherence to treatment and impaired healing. Chronic venous ulcers usually create relationship problems between patients and sanitary professionals. Chronic venous ulcers usually induce severe pain at rest. Pain increases with cleanings, debridement and dressing changes. Visual analog scale punctuation greater than or equal to 4 indicates significant and poorly controlled pain. Patients require a multidisciplinary therapeutic approach. An appropriate analgesic control is essential. The most commonly therapeutic drugs are oral analgesics (non steroids antiinflamatory drugs, acetaminophen, metamizole, tramadol, pregabalin, gabapentin and opioids) and topical anaesthetic creams, such as lidocaine or prilocaine. These therapies may induce several adverse effects and complications depending on the drug used and the characteristics of the patient. Sevoflurane is an inhaled halogenated anaesthetic agent with an adequate safety profile, used for induction and maintenance of general anaesthesia in hospital and ambulatory surgery. Its efficacy has been reported in a few case reports as a topical anaesthetic in leg ulcers. OBJECTIVES: Report the efficacy and safety of topical sevoflurane as a treatment for pain in chronic venous ulcers. Assess its analgesic, healing and antibacterial effect. See its impact on analgesic drugs, quality of life, functional capacity and health expenditure...
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Tesis de la Universidad Complutense de Madrid, Facultad de Medicina, leída el 16/02/2018