Keel D, Goldman M P
Dermatology Associates of San Diego County, Inc., La Jolla, California 92037, USA.
Dermatol Surg. 1999 May;25(5):371-2. doi: 10.1046/j.1524-4725.1999.08291.x.
The advantages of using tumescent anesthesia for ambulatory phlebectomy have recently been described. Previously, tumescent solutions have avoided epinephrine for concerns of toxicity given the large volume of anesthetic sometimes used.
To evaluate the efficacy and safety of using epinephrine in the tumescent anesthesia solution during ambulatory phlebectomy.
Over the course of 1 year, epinephrine in the concentration of 1:100,000 was added to the tumescent solution of patients undergoing ambulatory phlebectomy. A retrospective review of 94 sequential patients was performed to determine the rate of complications associated with the procedure.
The complication rate was considerably improved using tumescent lidocaine with epinephrine compared to a previously performed study of tumescent lidocaine without epinephrine. The rate of hematoma was decreased to nil while the rate of hyperpigmentation decreased from 3.6% to 0%. Overall, the rate of complications was improved when epinephrine was added to the tumescent lidocaine solution. Blood pressure measured every 5 minutes and heart rate measured continuously did not significantly change before, during or after infiltration of the anesthetic solution.
Epinephrine in appropriate concentrations is clearly safe when used in the tumescent anesthetic solution during ambulatory phlebectomy and should be used to reduce the incidence of hematoma and hyperpigmentation.
近期已有文献描述了在门诊静脉切除术使用肿胀麻醉的优势。此前，鉴于有时使用的麻醉剂体积较大，为避免毒性问题，肿胀液一直未使用肾上腺素。
评估在门诊静脉切除术中，在肿胀麻醉溶液中使用肾上腺素的有效性和安全性。
在1年的时间里，将浓度为1:100,000的肾上腺素添加到接受门诊静脉切除术患者的肿胀液中。对94例连续患者进行回顾性分析，以确定该手术相关并发症的发生率。
与之前一项未使用肾上腺素的肿胀利多卡因研究相比，使用含肾上腺素的肿胀利多卡因后并发症发生率显著改善。血肿发生率降至零，而色素沉着率从3.6%降至0%。总体而言，在肿胀利多卡因溶液中添加肾上腺素后并发症发生率有所改善。麻醉溶液浸润前、浸润期间和浸润后每5分钟测量一次的血压以及连续测量的心率均无显著变化。
在门诊静脉切除术中，适当浓度的肾上腺素用于肿胀麻醉溶液时显然是安全的，应用于降低血肿和色素沉着的发生率。
