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

Authors Al Wahbi AM

Received 21 February 2017

Accepted for publication 6 July 2017

Published 10 August 2017 Volume 2017:13 Pages 305—309

DOI https://doi.org/10.2147/VHRM.S135308

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Lucy Goodman

Peer reviewer comments 2

Editor who approved publication: Dr Daniel Duprez

Abdullah M Al Wahbi

Division of Vascular Surgery, Department of Surgery, King Abdulaziz Medical City, Riyadh, Saudi Arabia

Background: Endoluminal 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.
Methods: Sixty 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.
Results: No 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.
Conclusion: Ultrasound-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.

Keywords: femoral nerve block, endovascular laser ablation, tumescent anesthesia, varicose veins

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