sodium-bicarbonate and Varicose-Veins

Ambulatory Muller phlebectomy for varicose veins can be performed under local anesthesia. However, subcutaneous injection of local tumescent anesthetics may cause discomfort because of acidity of the solution. Addition of sodium bicarbonate lowers the acidity of anesthetic solutions, which might cause less pain. The objective of this study was to study whether alkalinization of the local anesthetic solution with sodium bicarbonate 1.4% decreases perioperative pain during Muller phlebectomies.. It is a double-blind single-center randomized controlled trial. In all, 101 patients scheduled for ambulatory Muller phlebectomy were randomized to receive either local anesthesia with alkalinized solution (lidocaine 1% and epinephrine in sodium bicarbonate 1.4%) or standard solution (lidocaine 1% and epinephrine in saline 0.9%). Primary outcome was pain during injection of local anesthetics with the use of the Visual Analogue Scale (VAS). Secondary outcomes were peroperative and postoperative pain, use of analgesics, patient satisfaction, return to function, and complications.. Patients receiving subcutaneous injection of local anesthetics diluted in sodium bicarbonate 1.4% experienced significantly less pain during injection compared with patients treated with standard anesthetic solution (VAS, 1.75 ± 1.8 vs. 3.55 ± 2.2, P < 0.00). Peroperative and postoperative pain, complication rates, use of analgesics, patient satisfaction, return to function, and complications did not differ between the 2 groups (P > 0.10).. Alkalinization of local anesthetic solution with sodium bicarbonate 1.4% significantly improves patient comfort during injection of local tumescent anesthesia.

Topics: Adult; Aged; Analgesics; Anesthesia, Local; Anesthetics, Local; Double-Blind Method; Female; Humans; Hydrogen-Ion Concentration; Injections, Subcutaneous; Kaplan-Meier Estimate; Lidocaine; Male; Middle Aged; Netherlands; Pain; Pain Measurement; Pain, Postoperative; Patient Satisfaction; Prospective Studies; Recovery of Function; Sodium Bicarbonate; Time Factors; Treatment Outcome; Varicose Veins; Vascular Surgical Procedures

Varicose veins are treated under local infiltration anesthesia. Literature shows that adding sodium bicarbonate reduces the pain associated with local infiltration anesthesia. Nonetheless, sodium bicarbonate is underused.. We sought to assess if the use of a solution of mepivacaine 2% plus adrenaline with sodium bicarbonate 1.4% results in less pain associated with local infiltration anesthesia preceding ambulatory phlebectomies, compared with standard preparation diluted with normal saline.. In all, 100 adult patients undergoing scheduled ambulatory phlebectomy were randomized to receive either a solution of mepivacaine chlorhydrate 2% plus adrenaline in sodium bicarbonate 1.4% or a similar solution diluted in normal saline 0.9%.. Median pain scores associated with local infiltration anesthesia reported in the intervention and control groups were 2 (SD=1.6) and 5 (SD=2.0) (P<.0001), respectively. A general linear model with bootstrapped confidence intervals showed that using the alkalinized solution would lead to a reduction in pain rating of about 3 points.. Patients were not asked to distinguish the pain of the needle stick from the pain of the infiltration. Moreover, a complete clinical study of sensitivity on the infiltrated area was not conducted.. Data obtained from this study may contribute to improve local infiltration anesthesia in ambulatory phlebectomy and other phlebologic procedures.

Topics: Adult; Aged; Ambulatory Care; Anesthesia, Local; Anesthetics, Local; Double-Blind Method; Epinephrine; Female; Humans; Injections, Subcutaneous; Isotonic Solutions; Male; Mepivacaine; Middle Aged; Pain; Pain Measurement; Sodium Bicarbonate; Sodium Chloride; Varicose Veins; Vasoconstrictor Agents

In order to simplify varicose vein surgery, we studied the possibility of tumescent local anaesthesia (TLA) using sodium bicarbonate 1.4% as excipient without any intravenous sedation.. For three months, 215 patients were included in two centres for ambulatory varicose vein surgery performed without any intravenous sedation. Clinical results and pain were evaluated according to the type and duration of surgery.. Mean perioperative pain was evaluated at 2.7 on a visual scale (0-10). In 91% of the cases, surgery was deemed to be slightly painful. Preoperative pain was not linked to the technical means of surgery but to the psychological and organizational environment of the centre.. In many of the cases, varicose vein surgery could be performed under TLA without any intravenous sedation. Ambulatory varicose vein surgery without any intravenous sedation could be highly cost-effective.

Topics: Adult; Aged; Aged, 80 and over; Ambulatory Surgical Procedures; Anesthesia, Local; Cost-Benefit Analysis; Female; France; Health Care Costs; Humans; Injections, Intravenous; Male; Middle Aged; Pain; Pain Management; Pain Measurement; Saphenous Vein; Sodium Bicarbonate; Time Factors; Varicose Veins; Vascular Surgical Procedures; Young Adult

Topics: Ambulatory Care; Anesthesia, Local; Female; Humans; Medication Errors; Middle Aged; Necrosis; Skin; Sodium Bicarbonate; Varicose Veins; Vascular Surgical Procedures

Topics: Anesthesia, Local; Epinephrine; Humans; Lipectomy; Postoperative Complications; Prilocaine; Sodium Bicarbonate; Varicose Veins