Comparison of tumescent versus ultrasound guided femoral and obturator nerve blocks for treatment of varicose veins by endovenous laser ablation

Abstract

Background: Endovenous laser ablation (EVLA) is a new method for treating greater saphenous vein insufficiency. Most of physicians use local anesthesia for needle punctures and tumescent anesthesia (TA) to prevent pain and protects the surrounding tissues from the conduction of heat that would originate from the effects of laser energy on the venous wall. The aim of this study is to compare the use of local tumescent anesthesia alone or combined with ultrasound guided femoral and obturator nerve blocks for treatment of varicose veins by endovenous laser ablation. Methodology: This is a randomized, double blind study included 80 patients scheduled for endovenous laser ablation for varicose veins of the great saphenous vein (GSV) located in the anterior or medial aspect of the leg were prospectively divided into two groups of 40 patients each. Group (A) had EVLA using tumescent anesthesia given by the surgeon. Group (B) had femoral and obturator nerves block before tumescent anesthesia was done. Intraoperative pain associated with applying the tumescent anesthesia and during performing ablation was measured using visual analogue scale. Volume of tumescent was compared in both groups. After finishing the operation, femoral and obturator motor block were evaluated. Postoperative VAS, time of stay in recovery area, patient and doctor satisfaction were also measured.

The Efficacy of Femoral Block and Unilateral Spinal Anaesthesia on Analgesia, Haemodynamics and Mobilization in Patients undergoing Endovenous Ablation in the Lower Extremity

“…Derin anestezi diğer yandan, safen ve sural sinirlerde istenmeyen hasarlara neden olabilmektedir (6). Endövenöz lazer ablasyon işlemi sırasında genel anestezi, epidural anestezi, hemispinal blok, femoral blok, siyatik blok ve bilinçli sedasyon gibi değişik anestezi yöntemleri uygulanmıştır (1)(2)(3)(4)(5)(6)(7)(8). Genel anestezinin bulantı-kusma, boğaz ağrısı ve miyalji gibi yan etkileri, santral blokların postoperatif bel ağrısı, postdural baş ağrısı, postural hipotansiyon ve bilinçli sedasyonun ise solunum depresyonu ve taburculuk süresini uzatması gibi yan etkileri mevcuttur (9, 10).…”

Anesthesia in outpatient phlebology practice

“…Для обезболивания ЭВЛО, РЧА и мини-флебэктомии применяется тумесцентная анестезия, для стриппинга -проводниковая анестезия, хотя возможна и комбинация этих видов анестезии [1][2][3][4][5]. Проводниковая анестезия -это обратимая блокада передачи нервного импульса по крупному нервному стволу (нерв, сплетение, узел) путем введения раствора местного анестетика в параневральное пространство.…”

“…Следует помнить, что проводниковая анестезия вызывает не только сенсорный, но и моторный блок [3,5]. В рекомендуемой дозе (табл.…”

Application of Femoral Nerve Block in Treating Great Saphenous Vein Insufficiency by Endovenous Radiofrequency Ablation Combined with Punctate Stripping

“…However, we found that multiple puncture injections into the skin would cause pain and discomfort to the patients, especially in the process of PS; the number of remedial injections and the amount of TAS were significant, significantly increasing pain, reducing comfort, and even affecting the surgical effect. It has been reported in the literature 8 , 9 that the application of ultrasound-guided femoral nerve block (FNB) combined with tumescent anesthesia (TA) in lower extremity varicose surgery has a better anesthetic effect than TA alone. However, applying ultrasound-guided FNB with TA in EVRA combined with PS is rarely reported.…”