Clinical Application Of Tumescent Anesthesia In High Ligation And Stripping Of The Great Saphenous Vein

ObjectiveTo explore the clinical effect of tumescent anesthesia in high ligation and stripping(HLS)of the great saphenous vein(GSV).Method131 consecutive patients with primary lower extremity varicose veins undergoing unilateral HLS of the GSV were included prospectively and randomly divided into Test group(Combined tumescent anesthesia with epidural anesthesia)and Control group(only epidural anesthesia).The primary indicators:postoperative skin ecchymosis,VAS(Visual Analogue Score)at days 1,2,and 3 postoperatively,CRP(C-Reactive protein)at preoperative and days 1,3 postoperatively,operative time,postoperative hospital stay,and hospitalization costs.The Secondary indicators:Adverse reactions caused by local anesthetics,including side effects and allergic reactions.SPSS 24.0 was used for statistical processing.Result1.A total of 130 patients had completed the study,including 63 in Test group and 67 in Control group.There were no significant differences in age,gender,left and right side of the affected limb,and CEAP classification between the two groups(all P>0.05).2.Postoperative skin ecchymosis was significantly reduced in Test group compared to Control group(1.00±1.24cm~2 VS.2.70±2.32cm~2,respectively),and the difference was statistically significant(P<0.05).3.The VAS of the two groups decreased gradually in the first three days after operation;The VAS in Test group was significantly lower than that in Control group at day 1(2.03±0.92 points VS.3.63±1.71 points respectively),day 2(1.64±0.72points VS.2.94±1.20 points),and day 3(1.17±0.66 points VS.2.16±1.03,respectively)postoperatively,and the difference was statistically significant(P<0.05).4.The CRP of the two groups increased gradually at the first three days after surgery;CRP values of Test group was significantly lower than that of Control group at the first day(5.64±5.37mg/L VS.7.67±5.87mg/L,respectively)and the third day(10.45±8.72mg/L VS.13.98±10.43mg/L,respectively)after operation,and the difference was statistically significant(P<0.05).5.On operation time(52.71±15.20 min VS.45.24±15.55 min,respectively),no significant difference between the two groups was found(P>0.05).Postoperative hospital stay in Test group was significantly shortened compared to Control group(3.43±0.82 day VS.3.75±0.99 day,respectively)(P<0.05).The hospitalization costs was reduced compared to Control group(10171±1857 yuan VS.10994±2088 yuan,respectively)(P<0.05).6.No adverse reactions related to tumescent anesthesia were observed in the test group.Conclusion1.Tumescent anesthesia in HLS can effectively reduce postoperative bleeding.2.Tumescent anesthesia in HLS can significantly relieve the pain at the first three days after surgery,and the pain-relieving effect improves gradually with time.3.Tumescent anesthesia in HLS can significantly reduce intra-operative trauma,enable early discharge,and reduce hospitalization costs,which is in line with the concept of ERAS(Enhanced Recovery After Surgery).4.The tumescent anesthetic fluid used in this study(Ropivacaine 0.03%,Adrenaline 1:2000000,and Sodium Bicarbonate 0.1%)is safe.