Local anesthesia with lidocaine and prilocaine, using the tumescent technique, for the radiofrequency ablation of lower extremity varicose veins.

AIM: To demonstrate the possible use of a tumescent solution containing lidocaine and prilocaine for radiofrequency-assisted segmental thermal ablation and to reduce the need for postoperative analgesics. METHODS: Fifty patients (51 limbs) underwent radiofrequency-assisted segmental thermal ablation (VNUS Closure FAST(™) ) of insufficient great and small saphenous veins and phlebectomy. The amount of tumescent fluid injected was noted, and evaluation of pain reported on visual analog scale (VAS) and quantity of the postoperative analgesics used and their side effects were recorded one day and six weeks after the procedure. RESULTS: The average amount of a tumescent fluid injected was 852 ml/patient (250-1470 ml). One day after surgery, 65% of the patients reported no pain (VAS 0), 27% reported a VAS of 1, and 4% reported a VAS of 2 on a scale of 0-10. Overall, 4% of the total patient population used analgesics after the procedure. Six weeks after the procedure, 84% of the patients reported no pain. CONCLUSION: Local anesthesia with lidocaine and prilocaine, and the tumescent technique, were found to be effective and safe modalities for radiofrequency ablation of varicose veins of the lower extremities.

Electrochemotherapy under tumescent local anesthesia for the treatment of cutaneous metastases.

BACKGROUND: The surgical management of cutaneous metastasis (CM) is challenging, particularly in elderly patients, in whom general anesthesia can be difficult because of comorbidity. OBJECTIVES: To test the effectiveness of tumescent local anesthesia (TLA) to achieve adequate anesthesia during the treatment of extensive CM with electrochemotherapy (ECT), previously only performed under general anesthesia. METHODS: We conducted five ECT treatments of CM with intralesional bleomycin under TLA. We examined pain scores before, during, and after treatment; analgesic use; and side effects. The intention of the treatment was palliative in all cases. RESULTS: We treated four patients (ages 75-88) with CM with a mean area of 126 cm(2) (range 12-198 cm(2) ) with 356 mL of TLA per treatment (range 180-450 mL). The ECT treatment under TLA demonstrated that anesthesia was adequate, with moderate pain during and slight pain after the procedure as measured on a visual analog scale (VAS). CONCLUSIONS: In this proof-of-principle study, we demonstrated that ECT can be performed under TLA; TLA might be a useful new anesthesia option for patients treated with ECT.

Local anesthesia in dermatology.

Local and regional anesthetic procedures are an integral part of daily dermatological practice. Safe and effective analgesia in skin and soft tissues is crucial for otherwise painful diagnostic or therapeutic interventions. Tumescent local anesthesia allows for pain-free interventions that previously had to be done by using general anesthesia. Older patients with multiple co-morbidities are especially suited for local anesthetic procedures, because they may significantly reduce surgical risks. For dermatologists, the knowledge of mode of action and toxicity of local anesthetics, as well as the emergency management of their potential complications, is essential.