Recomendaciones basadas en evidencia para el manejo del dolor neuropático en Atención Primaria en Salud (Revisión de la literatura) / Evidence-based recommendations for the management of neuropathic pain in Primary Healthcare (Review of the literature)

Snake bites (ophidism) constitute a public health problem in tropical and subtropical countries, due to their lethality, and the lack of access to prompt treatment in these regions. Catastrophic consequences follow the injection of the venom due to its proteolytic, procoagulant, hemorrhagic, nephrotoxic, vasculotoxic, and myonecrotizing properties, which can lead to severe complications if not managed promptly and adequately. In this report, we present the case of a 26-year-old male patient who suffered a snake bite (Bothrops asper) on the back of his right foot. Initially, he received eight vials of antivenom and was transferred to a specialized center. However, a few hours after his arrival, a necrotic wound developed on the back of the foot along with compartment syndrome, and hence emergency fasciotomies had to be performed and the patient was admitted to the ICU for multidisciplinary management and continuous monitoring. After 14 days, fasciotomy closure and eschar incision on the dorsum of the foot were performed along with an aesthetic reconstruction with an advancement flap and full-thickness graft. The patient had a satisfactory outcome thanks to the prompt evaluation and access to a unit with experience in managing highly complex cases. Our case highlights the importance of prompt and meticulous assessment after a snake bite due to its potential for causing highly complex clinical scenarios, and early diagnosis, proper management, and continuous multidisciplinary monitoring are key for a favorable prognosis. In many cases, these bites can lead to significant tissue loss and may necessitate the amputation of the affected limb. In severe cases, compartment syndrome frequently ensues and further complicates the management and increases morbidity if not recognized and managed promptly.