The Safety and Efficacy of Topical Sevoflurane on Painful Chronic Ulcers: A Comprehensive Systematic Review and Meta-analysis

Abstract

BackgroundChronic ulcers cause persistent pain and impaired healing, often showing resistance to standard therapies. Topical sevoflurane has emerged as a potential agent for both pain relief and wound healing; however, current evidence remains limited. This review assesses the safety and efficacy of topical sevoflurane in managing painful chronic ulcers and promoting a reduction in ulcer size.ObjectiveTo assess the safety and efficacy of topical sevoflurane as a promising drug compared with standard care.MethodsWe searched PubMed, Web of Science, Cochrane Library, and Scopus up to March 2025 for studies on topical sevoflurane in chronic ulcers. Meta-analysis was based on the Cochrane Handbook for Systematic Reviews of Intervention.ResultsOur meta-analysis showed that three studies (n = 127) demonstrated a significant reduction in pain with topical sevoflurane treatment, with a pooled Standardized Mean Difference (SMD) of -1.88 (95% CI: -2.31 to -1.44, <i>P</i> < .0001), and low heterogeneity (I² = 18.9%). Ulcer size reduction was also statistically significant in two studies (n = 79), with a pooled mean difference of -4.77 cm² (95% CI: -7.30 to -2.23, <i>P</i> = .0002), and moderate heterogeneity (I² = 30.0%). Effects were more pronounced at earlier assessment time points.ConclusionTopical sevoflurane shows promise for pain management in chronic ulcers, with potential benefits for healing and reducing opioid use. However, stronger evidence from high-quality studies is needed to support a definitive recommendation.