Surgical treatment of varicose vein using the tumescent technique of local anesthesia

Abstract

Background/Aim. Tumescent local anesthesia (TLA) is a technique for local and regional anesthesia of the skin and the subcutaneous tissue, using infiltration of large amounts of a diluted solution of local anesthetic. This technique is applied in plastic surgery, liposuction as well as in dermatology for the entire series of dermatocosmetic procedures. The purpose of this study was to determine efficiency of surgical treatment of varicose vein using TLA as an alternative method to a conventional treatment for varicose vein. Methods. Seventy-two patients with varicose vein were enrolled in the study. All of them were operated on applying TLA, from April 2008 to November 2009. TLA solution consisted of local anesthetics was used. TLA solutions used were: 1% prilocaine-chloride with adrenaline supplement, and 2% lidocaine-chloride and adrenaline in concentration of 0.1%-0.4%. Results. Out of 72 patients, we stripped great saphenous vein from 60 patient and did varicectomy as well as ligation of insufficiently perforating veins. In 12 patients we did partial varicectomy and ligation of perforating veins. There were not any patients with the need for continued surgery, as well as bringing patient to the general anesthesia due to pain during the surgery. One patient came for postoperative opening wound in the groin, one for infection of the wound and one for the formation of seroma in the groin. There were not any allergic reactions or systemic complications in the operations as well as postoperative period. Postoperatively, all the patients were treated with compressive elastic bandage during the period of 6 weeks as well as anticoagulation prophylaxis in the duration of 5 days. Conclusion. Surgery of varicose veins with implementation of TLA is easy and safe method with very low percentage of complications and unwanted effects. It is a good alternative method to classic surgery of varicose veins. The economic aspect is a very important component because the cost of this method is significantly lower than that of a classical surgical treatment of varicose veins.Uvod/Cilj. Tumescentna lokalna anestezija (TLA) je tehnika za lokalnu i regionalnu anesteziju koze i potkoznog tkiva, koriscenjem infiltracije velikih kolicina razblazenog rastvora lokalnog anestetika. Ova tehnika koristi se u plasticnoj hirurgiji, liposukciji, kao i u dermatologiji za citav niz dermatokozmetickih procedura. Cilj rada bio je da se utvrdi efikasnost hirurskog lecenja prosirenih vena koriscenjem TLA kao moguce alternativne metode klasicnom hirurskom lecenju. Metode. Ukupno 72 bolesnika sa prosirenim venama bilo je ukljuceno u studiju. Svi su operisani primenom TLA od aprila 2008. do novembra 2009. godine. Za tumescentni rastvor korisceni su lokalni anestetici i to 1% rastvor prilokain-hlorida uz dodatak adrenalina i 2% rastvor lidokain-hlorida sa adrenalinom u koncentraciji od 0,1% do 0,4%. Rezultati. Od ukupno 72 operisana bolesnika, kod njih 60 ucinjen je stripping vene safene magne uz parcijalnu varikotomiju, kao i podvezivanje insuficijentnih perforantnih vena, a kod 12 bolesnika ucinjena je parcijalna varikotomija i podvezivanje insuficijentnih perforantnih vena. Nije bilo potrebno nastaviti operaciju uvodjenjem bolesnika u opstu anesteziju zbog bolnosti operativnog zahvata. Kod jednog bolesnika doslo je do postoperativne dehiscencije rane u ingvinumu, kod jednog do infekcije rane i kod jednog do formiranja seroma u ingvinumu. Nije bilo alergijskih reakcija, niti sistemskih komplikacija u toku, kao ni posle operativnog zahvata. Postoperativno, svim bolesnicima postavljen je kompresivni elasticni zavoj, koji su nosili 6 nedelja. Takodje, svi su primali antitromboznu profilaksu niskomolekularnim heparinom u trajanju od 5 dana. Zakljucak. Hirursko lecenje prosirenih vena uz primenu TLA je lako izvodljiva i sigurna metoda sa vrlo niskim procentom komplikacija i nezeljenih dejstava, zbog cega predstavlja dobru alternativu klasicnoj hirurgiji prosirenih vena. Ekonomski aspekt je veoma znacajan s obzirom na to da su troskovi ove metode znacajno nizi u odnosu na klasicne metode hirurskog lecenja prosirenih vena.