ORIGINAL ARTICLES   

Giornale Italiano di Chirurgia Vascolare 1998 March;5(1):43-9

Copyright © 2000 EDIZIONI MINERVA MEDICA

language: English, Italian

Stripping of the great saphenous vein under local anesthesia using the “tumescent technique”. Technical notes

Ruju C., Montisci R., Brotzu G.

From the Department of Surgical Sciences and Organ Transplantation University of Cagliari, Cagliari, Italy

Background. The ­need to ­reduce ­costs and ­length of ­stay for sur­gery involv­ing the super­fi­cial ­venous cir­cu­la­tion, ­while main­tain­ing ­high qual­ity stan­dards, prompt­ed us to ­look ­into a spe­cial tech­nique ­with the aim of com­bin­ing the ­need for qual­ity and anes­thet­ic safe­ty ­with ear­ly dis­charge.
Methods. A pros­pec­tive ­study was ­made of 55 ­patients admit­ted to the sur­gery ­ward. All ­patients pre­sent­ed low­er ­limb var­i­cose ­veins requir­ing saph­e­nec­to­my, but ­were oth­er­wise in ­good ­health. Local anes­the­sia of the femo­ral ­nerve in Scarpa’s tri­an­gle was per­formed ­using 20 ml of a solu­tion of lid­o­caine 500 mg, sodi­um bicar­bo­nate 10 mEq and adren­a­line 0.75 mg dilut­ed in 1000 ml of a nor­mal ­saline solu­tion. Tissues ­around the saph­e­nous ­vein, iden­ti­fied ­using an ­echo Doppler tech­nique, ­were ­also infil­trat­ed ­with 300-600 ml of the ­same solu­tion, ­using a 30-cm ­blunt tip nee­dle. Saphenectomy was ­then per­formed ­using Babcock’s tech­nique.
Results. Analgesia was sat­is­fac­to­ry in all cas­es and no ­side ­effects of the anes­thet­ic solu­tion ­were report­ed. Subcutaneous bruis­ing was sig­nif­i­cant­ly ­reduced and ­patients ­were up 4 ­hours ­after sur­gery and dis­charged the fol­low­ing day.
Conclusions. We con­clude ­that the tech­nique ­described is ­easy to per­form, pro­vides opti­mal anal­ge­sia, has a low com­pli­ca­tions ­risk and ­helps to short­en the ­length of ­stay with­out decreas­ing the ­patient’s com­fort and safe­ty.