Bellam Krishna Prasad Premnath, Joy Binu, Sandhyala Abhilash, Naiknaware Kiran, Ray Brijesh
Consultant Interventional Radiologist, Department of Radiology, Rajagiri Hospital , Kochi, Kerala, India .
Head of Radiology Services, Department of Radiology, Rajagiri Hospital , Kochi, Kerala, India .
J Clin Diagn Res. 2016 Nov;10(11):TC13-TC17. doi: 10.7860/JCDR/2016/22897.8874. Epub 2016 Nov 1.
Laser ablation and sclerotherapy, as minimally invasive alternatives to surgery for varicose veins, have good efficacy, safety and cosmetic result. Some form of anaesthesia is generally used for pain control.
To describe the technique and evaluate the efficacy and safety of femoral, saphenous and sciatic nerve blocks in isolation or in combination for analgesia during laser ablation and sclerotherapy for lower limb varicose veins.
In this prospective observational study, over a period of 33 months, in 856 limbs of 681 patients with varicose veins, ultrasound guided femoral, saphenous and sciatic nerve blocks for analgesia were performed in 769, 808 and 52 instances respectively; following which, endovenous laser ablation, sclerotherapy or combination of both were carried out using standard practice. After completion of the procedure, Visual Analogue Pain Scale (VAS) was used for pain assessment, and muscle weakness was assessed clinically.
Nerve blocks could be successfully performed in all patients. Observed pain scores were 0 or 1 in 591 (69%), 2 or 3 in 214 (25%) and 4 in 51 (9%) legs with no score more than 4. Higher grades of pain were noted in femoral blocks during early stages of our learning curve. Mild to moderate muscle weakness was observed in 163 (2%) and 7 (13%) patients who underwent femoral and sciatic block respectively, which persisted for an average of two and a half hours and none beyond four and a half hours; saphenous nerve being a pure sensory nerve, did not cause motor weakness.
For analgesia during laser ablation and/or sclerotherapy of varicose veins, ultrasound guided nerve blocks can be easily and quickly performed. They provide excellent pain relief and comfort to the patient and to the operator; and they do not cause any additional complication.
激光消融和硬化疗法作为静脉曲张手术的微创替代方法，具有良好的疗效、安全性和美容效果。一般会使用某种形式的麻醉来控制疼痛。
描述在下肢静脉曲张激光消融和硬化疗法期间单独或联合使用股神经、隐神经和坐骨神经阻滞进行镇痛的技术，并评估其疗效和安全性。
在这项前瞻性观察研究中，在33个月的时间里，对681例静脉曲张患者的856条肢体进行了研究，分别对769例、808例和52例患者进行了超声引导下的股神经、隐神经和坐骨神经阻滞以镇痛；随后，按照标准操作进行静脉内激光消融、硬化疗法或两者联合治疗。手术完成后，使用视觉模拟疼痛量表（VAS）进行疼痛评估，并进行临床肌肉无力评估。
所有患者均能成功进行神经阻滞。观察到591条腿（69%）的疼痛评分为0或1，214条腿（25%）为2或3，51条腿（9%）为4，无评分超过4分的情况。在我们学习曲线的早期阶段，股神经阻滞中观察到较高等级的疼痛。分别有163例（2%）和7例（13%）接受股神经和坐骨神经阻滞的患者出现轻度至中度肌肉无力，平均持续两个半小时，无一例超过四个半小时；隐神经是纯感觉神经，未引起运动无力。
对于静脉曲张激光消融和/或硬化疗法期间的镇痛，超声引导下的神经阻滞可以轻松、快速地进行。它们为患者和操作者提供了出色的疼痛缓解和舒适感，且不会引起任何额外并发症。
