Evaluation of pain during endovenous laser ablation of the great saphenous vein with ultrasound-guided femoral nerve block

Abstract

BackgroundEndoluminal laser ablation is now considered the method of choice for treating greater saphenous vein insufficiency. General anesthesia and peripheral nerve blocks with sedation have the risk of post-procedural delay in discharge and prolonged immobilization with the risk of deep vein thrombosis. The main pain experienced by patients during the procedure is during the laser ablation and the multiple needle punctures given along and around the great saphenous vein. The aim of our study was to evaluate the safety and efficacy of blocking the femoral nerve only under ultrasound-guidance without sedation, to reduce or prevent pain during injectable tumescent anesthesia in endovenous laser ablation of the greater saphenous vein.MethodsSixty patients in two groups underwent endovenous laser ablation for the greater saphenous vein insufficiency at an outpatient clinic. All patients received tumescent anesthesia. However, one group received a femoral nerve block (FNB) under ultrasound guidance before the procedure. All patients were asked to record the pain or discomfort, using the visual analog score, from the start of the procedure until the end of the great saphenous vein laser ablation. The length of the great saphenous vein and duration of the procedure were also recorded. The results were analyzed using statistical methods.ResultsNo complications from FNB were observed. The pain associated with application of tumescent anesthesia and laser ablation was more intense in the group without an FNB (P < 0.001). There was no significant difference between the two groups in the length of the great saphenous vein or procedure duration.ConclusionUltrasound-guided FNB (without other peripheral nerve blocks) is a safe, adequate, and effective option to decrease and/or eliminate the intraoperative discomfort associated with tumescent anesthesia injections and laser ablation during endoluminal laser ablation of the greater saphenous vein.

Peripheral regional anaesthesia and outcomes: a narrative review of the literature from 2013 to 2023

“… 58 , 59 Endovenous laser ablation is also described as an indication for femoral nerve block. 60 , 61 …”

“…The majority of femoral nerve blocks used ultrasound guidance (22 studies), 23 , 26 , 28 , 29 , 30 , 31 , 32 , 33 , 35 , 36 , 37 , 39 , 42 , 47 , 48 , 49 , 54 , 56 , 57 , 59 , 60 , 61 but 10 studies used nerve stimulation, 22 , 27 , 34 , 40 , 41 , 44 , 45 , 46 , 50 , 52 and eight studies did not report the nerve identification technique or were not clear in their description. 24 , 25 , 38 , 43 , 51 , 53 , 55 , 58 …”

Femoral nerve block versus spinal anesthesia in the treatment of saphenous vein ablation

“…[11] Dzieciuchowicz et al [12] used femoral nerve block with 20 mL of 1% lidocaine in addition to TA in one of the two different groups who underwent endoluminal laser ablation and tumescent ablation in the other, and reported that pain intensity and need for TA solution were lower in the group they added femoral nerve block. Al Wahbi [13] also reported that femoral nerve block added to TA during endoluminal laser ablation decreased pain intensity without affecting the surgical duration. As the target nerve was completely localized with ultrasonography and a mixed solution was used in our study, a total volume of 20 mL was sufficient in the femoral nerve group without the need for relatively high local anesthetic injections used for TA, and surgical duration was not affected and no additional analgesia was needed.…”

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.…”