Laser for snake bite
Trial question
What is the role of photobiomodulation therapy in patients with Bothrops atrox envenomation?
Study design
Single center
Single blinded
RCT
Population
Characteristics of study participants
13.0% female
87.0% male
N = 60
60 patients (8 female, 52 male).
Inclusion criteria: adult patients with a clinical-epidemiologic diagnosis of Bothrops atrox envenomation.
Key exclusion criteria: hospital admission > 24 hours after the bite; antivenom therapy administration at another health facility prior to hospital admission; secondary infection; pregnancy; diabetes; immunocompromised state; ulcers or other types of wounds by other causes in the affected limb.
Interventions
N=30 photobiomodulation therapy (low-level laser therapy, 4 J/cm² for 40 seconds, combined with regular antivenom treatment).
N=30 regular antivenom treatment (regular antivenom treatment alone).
Primary outcome
Mean creatine kinase 48 hours after admission
163.7 U/L
412.4 U/L
412.4 U/L
309.3 U/L
206.2 U/L
103.1 U/L
0.0 U/L
Photobiomodulation
therapy
Regular antivenom
treatment
Significant
decrease ▼
Significant decrease in mean CK 48 hours after admission (163.7 U/L vs. 412.4 U/L; MD -248.7, 95% CI -473.68 to -23.72).
Secondary outcomes
Significant decrease in mean pain intensity at 48 hours (2.9 vs. 5; MD -2.1, 95% CI -3.53 to -0.67).
Significant decrease in mean limb circumference measurement ratio (6.6% vs. 17.1%; RR 0.39, 95% CI 0.16 to 0.62).
Significant decrease in mean edema extent in affected limb (25.8 cm vs. 40.1 cm; MD -14.3, 95% CI -23.35 to -5.25).
Safety outcomes
No significant difference in secondary infections.
Conclusion
In adult patients with a clinical-epidemiologic diagnosis of Bothrops atrox envenomation, photobiomodulation therapy was superior to regular antivenom treatment with respect to mean CK 48 hours after admission.
Reference
Érica da Silva Carvalho, Andrea Renata do Nascimento Souza, Dessana Francis Chehuan Melo et al. Photobiomodulation Therapy to Treat Snakebites Caused by Bothrops atrox: A Randomized Clinical Trial. JAMA Intern Med. 2024 Jan 1;184(1):70-80.
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