Patient-perceived outcomes of different anaesthetic techniques in classical surgical treatment of varicose veins of lower limbs.

AIM OF THE STUDY: To evaluate the effects of spinal or locoregional anaesthesia versus local tumescent anesthesia during traditional surgical treatment of saphenous reflux, in terms of pain and postoperative functional recovery. MATERIALS AND METHODS: From January to December 2014, 195 consecutive interventions of stripping of the greater saphenous vein for valvular incompetence were performed. In 114 cases spinal or locoregional anaesthesia was performed (group 1), in the remaining 81 cases local anaesthesia with the tumescence technique was carried out (group 2). All patients underwent an assessment of perceived pain by means of verbal rating scale before and at the end of surgery, at discharge and after a month. The times of recovery of ambulation during hospital stay and at the discharge were recorded and use of analgesic drugs during hospitalization and at home. At the end of the study, patients were asked to express their approval rating on the type of anaesthesia. RESULTS: Patients in group 2 experienced mild to moderate intraoperative pain more frequently than patients in group 1 (p<0.001), while patients in group 1 had more mild adverse anaesthesia-related events than patients in group 2. Patients in group 2 had faster recovery of ambulation and earlier discharge than patients in group 1.Thirty-day results were similar in the two groups; however, patients in group 2 had a higher degree of satisfaction than patients in group 1 with regard to the type of anaesthesia (p<0.001) CONCLUSIONS: Both locoregional and local tumescent anaesthesia are effective and well accepted by the patients, with similar intra-hospital and 30-day results. KEY WORDS: Great Saphenous Vein, Local tumescent anaesthesia, Pain, Stripping.

[Linee guida flebo-linfologiche SIF-SICVE 2016 della Società Italiana di Flebologia e della Società Italiana di Chirurgia Vascolare ed Endovascolare].

Phlebology is not a specialty for its own in Italy. Phlebological patients are treated by vascular and general surgeons, dermatologists, phlebologists, angiologists, internists and even general practitioners. Even tough guidelines present a series of recommendations based on evidence-based medicine, guidelines may also be a tool to unify the diagnostic and therapeutic approach in a vast medical field like phlebology. Since vascular surgeons and phlebologists are particularly involved in phlebology-related pathologies the scientific societies of the Italian Society of Phlebology (SIF) and the Italian Society for Vascular and Endovascular Surgery (SICVE) decided to cooperate for the preparation of phlebo-lymphological guidelines. These guidelines comprehend also an important chapter dealing with the lymphology of the lower extremities; phlebological active physicians are often faced with lymphatic pathologies and a good differential diagnosis can be sometimes very helpful. Sclerotherapy and Surgery as the major therapeutical alternatives are extensively analyzed, but also the compression therapy, the medical and physical therapy are presented under the critical view of evidence based analyses. Separate chapters deal with the treatment alternatives for superficial and deep venous thromboses and the recommendations for the treatment of venous ulcers. The current scientific evidences were confronted with the experiences of Italian specialists and the particular practice and reality in Italy. They represent therefore the actual valid positions and recommendations in Italy which shall be updated regularly.