Comparing local tumescent anesthesia and spinal anesthesia methods during and after endovenous radiofrequency ablation of vena saphena magna that includes mini-phlebectomy operations

Background: Local or spinal anesthesia methods can be used during radiofrequency ablation (RFA) of the great saphenous vein. There is a gap in the literature regarding comparing and contrasting the side effects of the mentioned two methods. This study aims to retrospectively compare the spinal anesthesia method with the local tumescent anesthesia method during RFA of the great saphenous vein that also includes mini-phlebectomy.

Methods: We retrospectively analyzed patients who underwent RFA and mini-phlebectomy divided in two groups according to the anesthesia applied method. Group 1 contained patients who underwent the RFA operation under spinal anesthesia combined with tumescent anesthesia, and group 2 patients consisted of patients who underwent the same process under local tumescent anesthesia. Pain scores, the time length of preparation interval of anesthesia and the operation time, anesthesia-related side effects such as headache, nausea-vomiting, urinary retention, quality of life scores, postoperative occlusion rates, and complications related to the intervention such as phlebitis, deep vein thrombosis (DVT) were analyzed and compared via Mann Whitney U, Wilcoxon and Chi-Square tests.

Results: Between June 2015 and June 2019 a great saphenous vein RFA ablation was performed in 175 patients. A total of 103 limbs were performed under spinal anesthesia combined with tumescent anesthesia and a total of 72 limbs were performed under local tumescent anesthesia. Mini phlebectomy was applied to all patients. Pain scores of the spinal anesthesia group were lower than the other group, and there was a significant difference. There was no significant difference between the operation lengths of both groups, but the preparation phase of anesthesia was shorter in local tumescent anesthesia patients, and the difference was significant. Anesthesia related side effects such as headache, nausea-vomiting, and urinary retention showed a significant difference between the two groups, and they were lower in the local tumescent anesthesia group. Preoperative quality of life scores of both groups decreased postoperatively. The postoperative occlusion rate of group 1 was 96.1%, and group 2 was 100 % at three months, but the difference was not significant. We encountered 3 cases of phlebitis, 2 cases of DVT and 2 cases of bruising in group 1, and 1 case of bruising in group 2. There was no postoperative paresis or paresthesia in either groups.

Conclusions: This monocenter and retrospective report of 175 GSV RFA using tumescent local anesthesia or spinal anesthesia combined with local tumescent anesthesia demonstrares that both methods of anesthesia are effective. Although the pain scores are better with spinal anesthesia, the local tumescent anesthesia method is more efficient, requiring a shorter time, and is associated with fewer complications such as headache, nausea-vomiting, or urinary retention and deep venous thrombosis.