Al Wahbi Abdullah M
Division of Vascular Surgery, Department of Surgery, King Abdulaziz Medical City, Riyadh, Saudi Arabia.
Vasc Health Risk Manag. 2017 Aug 10;13:305-309. doi: 10.2147/VHRM.S135308. eCollection 2017.
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.
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.
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 ( < 0.001). There was no significant difference between the two groups in the length of the great saphenous vein or procedure duration.
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.
腔内激光消融术目前被认为是治疗大隐静脉功能不全的首选方法。全身麻醉和联合镇静的周围神经阻滞存在术后出院延迟以及长时间制动导致深静脉血栓形成的风险。患者在手术过程中主要的疼痛发生在激光消融以及沿大隐静脉及其周围进行的多次针刺过程中。我们研究的目的是评估在超声引导下仅阻滞股神经且不使用镇静剂，以减轻或预防大隐静脉腔内激光消融术中注射肿胀麻醉时的疼痛的安全性和有效性。
两组共60例患者在门诊接受大隐静脉功能不全的腔内激光消融术。所有患者均接受肿胀麻醉。然而，一组在手术前接受超声引导下的股神经阻滞（FNB）。所有患者被要求使用视觉模拟评分记录从手术开始到大隐静脉激光消融结束时的疼痛或不适。还记录了大隐静脉的长度和手术持续时间。使用统计方法对结果进行分析。
未观察到FNB的并发症。未进行FNB的组中，与应用肿胀麻醉和激光消融相关的疼痛更强烈（<0.001）。两组在大隐静脉长度或手术持续时间方面无显著差异。
超声引导下的FNB（不进行其他周围神经阻滞）是一种安全、充分且有效的选择，可减少和/或消除大隐静脉腔内激光消融术中与肿胀麻醉注射和激光消融相关的术中不适。
