Tumescent Anesthesia Research Articles

Gangrenous Bowel Obstruction Managed With Local Tumescent Anesthesia and MAC

Since the mid-1980s, Klein’s tumescent anesthesia has been used routinely in different surgical specialties such as cosmetic surgery, dermatology, vascular surgery, reconstructive plastic surgery, and breast surgery. The tumescent anesthesia technique was developed by Dr Jeffrey Klein, a board-certified dermatologist. The technique was first published in 1987. Tumescent means “swelling.” This technique involves injection of an ultra-dilute lidocaine and epinephrine solution into the surgical planes offering multiple advantages including, but not limited to, postoperative analgesia, reduced blood loss, and avoidance of general anesthesia. The standard liter of Klein’s solution contains lidocaine 1 g, epinephrine 1 mg, and sodium bicarbonate 12.5 mg. Multiple modifications and variations have been implemented and used over the years, an evolution from Klein’s original description. While tumescent anesthesia started in liposuction procedures, its application has now extended into a wider variety of procedures and specialties. In this article, we present a case of tumescent anesthesia in a critically ill general surgery patient who presented with an acute life-threatening surgical emergency. The patient was assessed to be a very high risk for general anesthesia, and after collaborative discussion between the surgical and anesthesia teams and taking informed consent from the patient, the decision was made to proceed with surgery under monitored intravenous sedation with tumescent anesthesia. The patient had an uneventful recovery and survived a very high mortality surgical emergency. He was subsequently discharged back to his nursing home in stable condition. Tumescent anesthesia has become tremendously popular in cosmetic surgery. Tumescent anesthesia allows patients to have surgical procedures in an ambulatory setting, avoid general anesthesia, and allow for better pain control postoperatively. While tumescent anesthesia is used in other specialties, the field of general surgery has not widely adopted tumescent anesthesia. Many general surgeons and anesthesiologists are not familiar with the technique and how to implement it in their practice. It is of utmost importance to understand the pharmacokinetics of tumescent solution and safe implementation. Tumescent anesthesia with monitored anesthesia care is here reported as an alternative to general anesthesia in the care of a moribund patient with multiple comorbidities requiring open abdominal surgery. Close cooperation between the surgeon and the anesthesiologist made the successful conduct of this case possible.

Femoral nerve blockade during endovenous laser ablation of great saphenous vein decreases pain but does not affect the use of opioids during the procedure

BackgroundEndovenous laser ablation (EVLA) using tumescent anesthesia for treatment of an insufficient great saphenous vein (GSV) can be painful and require intravenous pain management and, sometimes, sedation with propofol. Femoral nerve blockade (FNB) anesthetizes the femoral nerve distribution and is usually used for anterior thigh and knee procedures. It is easy to inject with ultrasound guidance because the nerve is easy to visualize in the groin. The aim of the present double-blind, randomized controlled trial was to determine whether FNB before tumescent anesthesia decreases the pain of GSV EVLA combined with local phlebectomy. MethodsEighty patients who underwent GSV EVLA combined with local phlebectomy under tumescent anesthesia were randomized into two groups. The placebo group (control group; 40 patients) was given placebo FNB with 0.9% saline before tumescent injection. The FNB group (intervention group; 40 patients) received 1% lidocaine with adrenaline for FNB before tumescent injection. Only the study nurse, who performed the randomization, knew which patients were in which group. The patients and operating surgeon were unaware of the randomization group. FNB was performed under ultrasound guidance. The effectiveness of anesthesia was tested 10 minutes after injection using the pin-prick test and a numeric rating scale (NRS). The NRS was completed before and during tumescent anesthesia and during EVLA ablation and local phlebectomy. The motor function of the femoral nerve was tested at the end of the procedure and 1 hour after using the Bromage method. Patients had a follow-up visit 1 month after the procedure, and their need for pain medication and the duration of sick leave were recorded. ResultsNo differences were found in the gender distribution, age, or GSV dimensions at baseline. The mean length of the treated GSV segment was 28 cm and 30 cm and the mean energy used was 1911 J and 2059 J in the placebo and FNB groups, respectively. The median NRS score for pain during tumescent injection around the GSV was 2 (interquartile range [IQR], 1-4) in the placebo group compared with 1 (IQR, 1-3) in the FNB group. Very little pain was experienced during laser ablation. The median NRS score was 0 (IQR, 0-0) and 0 (IQR, 0-0.75) in the placebo and FNB groups, respectively. The most painful stage was injection of tumescence to the local phlebectomy sites in both groups. The median NRS score was 4 (IQR, 3-7) in the placebo group and 2 (IQR, 1-4) in the FNB group (P = .01). During local phlebectomy, the NRS score was 2 (IQR, 0-4) vs 1 (IQR, 0-3) in the placebo and FNB groups, respectively. Only the difference in pain during injection of tumescence before local phlebectomy was significant. ConclusionsFNB seems to decrease pain during EVLA combined with local phlebectomy. Patients experienced the highest pain when tumescence was injected before local phlebectomy, and those in the FNB group experienced significantly less pain than the placebo group. No indication for routine use of FNB is indicated. However, it could be used to decrease the pain for patients who experience strong pain during varicose vein surgery, especially if extensive local phlebectomies are required.

Clinical analysis of tumescent anesthesia technique combined with superficial fascia rotational atherectomy in axillary bromhidrosis.

Axillary bromhidrosis, which involves the apocrine sweat glands, severely affects adolescents. The present study aimed to evaluate the effect of tumescent anesthesia technique combined with superficial fascia rotational atherectomy treatment for axillary bromhidrosis. The present retrospective study included a total of 60 patients with axillary bromhidrosis. These patients were divided into experimental and control groups. Patients in the control group were treated using the tumescent anesthesia technique combined with conventional surgery, while patients in the experimental group were treated using the anesthesia technique combined with superficial fascia rotational atherectomy. The intraoperative blood loss, operation time, histopathological examination and dermatology life quality index (DLQI) score were used to assess the treatment effect. The intraoperative blood loss and operation time were significantly lower in the experimental group compared with the control group. The histopathological results revealed that the sweat gland tissues in experiment group significantly decreased compared with that in control group. Furthermore, there was a significant improvement in axillary odor degree for postoperative patients, and the DLQI scores in experiment group were significantly lower compared with those in control group. The tumescent anesthesia technique combined with superficial fascia rotational atherectomy is a promising approach to treating patients with axillary bromhidrosis.

Outcomes of Intramuscular Gluteal Augmentation With Implants Using Tumescent Local Anesthesia

BackgroundTumescent local anesthesia (TLA) describes the practice of injecting a very dilute solution of local anesthetic combined with epinephrine and sodium bicarbonate into the tissue until it becomes firm and tense to obtain local anesthesia and vasoconstriction. The use of TLA in augmentation intramuscular gluteoplasty has never been described for implants positioning. Advantages of the TLA technique include a reduction in blood loss through epinephrine-induced vasoconstriction and hydrostatic compression from the tumescent effect. We describe TLA technique for primary intramuscular gluteal augmentation, reporting our experience during the last 5 years.MethodsFrom 2017 to 2021, 20 patients underwent bilateral primary gluteal augmentation under TLA and conscious sedation. The tumescent solution was prepared with 25 mL of 2% lidocaine, 8 mEq of sodium bicarbonate, and 1 mL of epinephrine (1 mg/1 mL) in 1000 mL of 0.9% saline solution. The solution was infiltrated with a cannula inside the gluteus maximus muscle intra-operatively.ResultsThe mean age of the patients was 39, 15 years. The average amount of tumescent solution infiltrated was 240 mL per gluteus. Operating time was 1 h and 40 min, and recovery room time averaged 240 min. Major surgery-related complications were found in 15% of patients (2 hematomas and 1 seroma) and minor complications were described in a total of 8 patients (4 wound dehiscence and 1 dystrophic scar formation). No signs of adrenaline nor lidocaine toxicity were reported and conversion to general anesthesia was never required.ConclusionsThe tumescent local anesthesia technique represents a safe and efficacious technique for performing gluteal augmentation surgery with an intramuscular implant positioning. The advantages of this technique are safety, reasonable pain control during and after surgery and a low incidence of postoperative side effects due to general anesthesia avoidance.Level of Evidence IVThis journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Drill from Military to Operating Theater and Safe Reuse of Single-Use Items to Combat the Cost of Optical Fibers and Consumables in Endovenous Laser Ablation of Varicose Veins

Introduction: Can the tandem arrangement of operating theater setup to perform a surgical drill similar to military, together with safe reuse of single-use items combat the cost of consumables of endovenous laser ablation (EVLA)? Methods: Operation pathway of EVLA consisted of cleaning and draping of patient (step 1), access to the affected vein and infiltration of tumescent local anesthesia (step 2), endovenous ablation (step 3), ultrasound-guided microfoam sclerotherapy (step 4), and chemical sterilization of consumables (step 5). Dedicated theater lists for EVLA were arranged to treat several patients per session in a prearranged operating theater. When the step 5 is completed on the first patient, the step 1 on the next patient was performed using sterilized optical fiber (OF) as a cycle while minimizing patient changeover time. Number of patients treated with each session of OF and time taken for step 1 to step 4 was recorded and analyzed. Results: A total of 140 patients treated using eight OFs during December 2019 to December 2022. Average number of patients treated with a single OF and during a single session of fiber is 17.5 (9–23) and 4.2 (3–7), respectively. Average time taken for step 1 was 7.83 min, step 2 was 7.95 min, step 3 was 1.57 min, and step 4 was 6.36 min. All the procedures were performed using four chemically re-sterilized guidewires and introducer sheaths. Conclusion: Tandem arrangement of operating theater to perform EVLA procedure similar to military drill can optimize the utilization of OFs and consumables.

Comprehensive Analysis of Local Anesthetics Affecting Adipose Stem Cells In Vitro.

Adipose stem cells (ASCs) hold a great regenerative capacity because of their differentiation capability and their secretory activity. Thus, ASC survival is of great significance during perioperative harvesting. Various local anesthetics are commonly applied during fat grafting procedures. These substances are known to impair cellular viability, which would affect graft survival and final outcomes, but the exact extent of their impact on ASC biology is unknown. The authors analyzed the short- and long-term effects of lidocaine, mepivacaine, ropivacaine, and bupivacaine at increasing concentrations (0.1 to 10 mM) on primary human ASC proliferation and metabolic activity. Trilinear differentiation was assessed by oil red O stain (adipogenesis), safranin O (chondrogenesis), and cresolphthalein (osteogenesis) labeling. In supernatants, cytokine [interleukin (IL)-6/IL-8, vascular endothelial growth factor, hepatocyte growth factor] secretion was analyzed by enzyme-linked immunosorbent assay. Bupivacaine at greater than 100 µM demonstrated the strongest anti proliferative effects, whereas lidocaine and ropivacaine did not affect cell numbers. Mepivacaine evoked reciprocal results regarding cell count at greater than 1 mM. Each compound impaired trilinear differentiation. Secretion of hepatocyte growth factor and IL-8 was reduced significantly by local anesthetic exposure; levels were restored after substances were washed out. In vitro data show that lidocaine, mepivacaine, and ropivacaine could be applied at concentrations of 1 to 10 mM without affecting ASC survival. In contrast, bupivacaine at concentrations greater than 100 µM should be administered with great caution. The differentiation of ASCs and the ASC's secretome might already be decreased by each local anesthetic at 1 mM. The authors' experimental data can be of great significance to the clinical practice, as local anesthetics are routinely administered during liposuction as a tumescent anesthesia adjunct. Therapeutic, V.

Comparison of Tumescent Anesthesia Versus Pectoral Nerve Block in Bilateral Reduction Mammaplasty.

With an increasing focus on multimodal pain control to reduce opioid requirements, regional and local anesthesia techniques have been investigated in bilateral reduction mammaplasty with variable results. The purpose of this study is to compare tumescent anesthesia with pectoral nerve block II (PECS II) in patients undergoing bilateral reduction mammaplasty with respect to postoperative pain and nausea, opioid consumption, length of stay, and cost. A retrospective review of patients undergoing bilateral reduction mammaplasty for macromastia between November 2020 and December 2021 was performed. Demographic information, operative and anesthesia times, antiemetic and morphine equivalent requirements, postoperative numeric pain rating scales, and time until hospital discharge were compared between groups. χ2 and Fisher exact tests examined subgroup differences in categorical variables. Two-sample t test and Wilcoxon rank-sum test evaluated differences in continuous parametric and nonparametric variables, respectively. Fifty-three patients underwent bilateral reduction mammaplasty by 3 surgeons, 71.7% (n = 38) with tumescent anesthesia infiltrated by the operating surgeon before the start of the procedure and 28.3% (n = 15) with bilateral PECS II blocks performed by anesthesia before the start of the procedure. There was no difference in age, body mass index, weight resected, intraoperative medication, or immediate postoperative complications. Postoperative pain scores and opioid requirements were similar between the 2 groups. Twenty-one percent (n = 8) of tumescent patients compared with 66.7% (n = 10) of block patients required 1 or more doses of postoperative antiemetics ( P = 0.002). Patients who received blocks spent longer in the postoperative recovery area (5.3 vs 7.1 hours, P < 0.01). However, this did not translate to a significant increase in overnight stays. The block group had significantly higher hospitalization cost by an average of $4000, driven by pharmacy and procedural cost ( P < 0.01). In this cohort of multimodal perioperative pain-controlled reduction mammaplasty patients, tumescent anesthesia was associated with decreased antiemetic requirements, less time in recovery before discharge, and lower cost compared with PECS II blocks. Therefore, tumescent anesthesia may be favored over PECS II blocks when considering multimodal pain control strategies in reduction mammaplasty patients.

Tumescent local anaesthesia for the surgical therapy of congenital nevi in the first year of life.

The indication for surgical treatment of congenital nevi must be made after individual consideration of the expected benefit and risk and requires careful information of the parents as well as interdisciplinary psychological support. In addition to suspected malignancy, a relevant indication is the risk of stigmatization depending on the size and localization of the nevus. Objective was to show which size reduction of the congenital nevus can be achieved by surgical therapy under tumescent local anaesthesia (TLA) in infancy and how often complications of anaesthesia or surgery occur. All infants up to 12 months of age who underwent surgery for a congenital nevus under TLA at the University Dermatological Clinic Tuebingen between January 2015 and December 2021 were included; surgeries were performed using serial excisions (powerstretching technique), whereby the incisions were made inside the nevus and mobilization was strictly limited to the skin side without nevus. Overall, a cumulative total area of 38.65 cm2 could be removed on average within the first year of life (trunk: 67 cm2 , head: 21.2cm2 , legs: 21.6cm2 , arms: 13.2cm2 ). A cumulative maximum area reduction of 406.9cm2 could be achieved. We evaluated 363 surgical sites (123 children) on all body regions. The median age of the children at the first surgery was 3.5months (0.46-10.7months). Complications occurred in 2.3% (seven procedures). All these complications were reversible in the course of the operation and did not lead to a prolonged hospital stay. No anaesthesia-related complications occurred. We were able to show that a reduction of large areas of congenital nevi is possible in the first year of life with the combination of serial excisions using powerstretching technique, TLA, and intracutaneous butterfly sutures.

Clinical outcomes following mechanochemical ablation of superficial venous incompetence compared with endothermal ablation: meta-analysis.

Mechanochemical ablation (MOCA) is an alternative method to endovenous thermal ablation (EVTA) for the treatment of superficial venous incompetence that does not require tumescent anaesthesia. The aim of this study was to compare the outcomes from RCTs of MOCA versus EVTA. A search was conducted in MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials (CENTRAL). Meta-analysis inclusion was restricted to RCTs comparing MOCA against EVTA. Outcomes included anatomical occlusion rate, disease-specific quality of life using the Aberdeen Varicose Vein Questionnaire, procedural and postprocedural pain, and rates of venous thromboembolism. Four RCTs were included in the meta-analysis comprising 654 patients. The anatomical occlusion rate at 1 year was lower after MOCA than EVTA (risk ratio 0.85, 95 per cent c.i. 0.78 to 0.91; P < 0.001). No significant differences were detected in procedural pain (mean difference -3.25, -14.25 to 7.74; P = 0.560) or postprocedural pain (mean difference -0.63, -2.15 to 0.89; P = 0.420). There were no significant differences in Aberdeen Varicose Vein Questionnaire score at 1 year (mean difference 0.06, -0.50 to 0.62; P = 0.830) or in incidence of venous thromboembolism (risk ratio 0.72, 95 per cent c.i. 0.14 to 3.61; P = 0.690). The rate of successful anatomical occlusion after MOCA is significantly lower than that after EVTA, but there is no difference in procedural and postprocedural pain between the two interventions. Long-term data are required to assess the impact of the reduced vein occlusion rate on clinical outcomes such as quality of life and reintervention.

Back to the future: breast surgery with tumescent local anesthesia (TLA)?

PurposeBreast surgery is usually performed under general anesthesia. Tumescent local anesthesia (TLA) offers the possibility to anesthetize large areas with highly diluted local anesthetic.MethodsIn this paper, the implementation, and experiences with TLA in the field of breast surgery are discussed.ConclusionFor carefully selected indications, breast surgery in TLA represents an alternative to ITN.

A comparative study of tumescent anaesthesia (0.1% lignocaine with adrenaline) versus 2% lignocaine for episiotomy

Introduction: Tumescent anaesthesia is a practice of giving a very dilute form of local anaesthesia drug combined with epinephrine to a tissue till the tissue becomes firm and tense (tumescent). Delivery is a physiological procedure associated with great pain, which is in turn added by the episiotomy procedure. Advantage of using tumescent anaesthesia as a local anaesthetic agent include that it reduces the blood loss by both epinephrine induced vasoconstriction and hydrostatic compression from the tumescent effect. Tumescent lignocaine absorbed slowly from subcutaneous tissue that produces lower & more delayed peek serum levels and also extended analgesic effect after procedure.Aim and Objectives: To compare the effects of tumescent anaesthesia over 2% lignocaine for episiotomy in patients delivering via labour natural in Rajah Muthiah Medical College and Hospital, Chidambaram. To study the effectiveness of tumescent anaesthesia in decreasing blood loss at episiotomy site. To study the effectiveness of tumescent anaesthesia in reducing pain and prolonging the analgesic effect. To study the effectiveness of tumescent anaesthesia aiding in demarcation of layers of episiotomy wound while repairing.Materials and Methods: To the patients who progress for vaginal delivery in stage two of labour before crowning of fetal head 10 ml of 2% lignocaine and 10 ml of tumescent anaesthesia [0.1% lignocaine with adrenaline) to be instilled into the perineal skin at the episiotomy site left mediolateral (By randomised selection of patients). When fetal head crowns episiotomy to be given and baby to be delivered. After removal of the placenta, episiotomy wound will be sutured in layers.Results: The mean Duration of analgesia in Group A was 93.467 ± 17.4529 & group B was 198.100 ± 12.0669 with P value less than 0.05, which was statistically significant. The mean time of suturing episiotomy n group A was 22.19 ± 1.642 and group B was 12.45 ± 1.947 with P value <0.05, which was statistically significant.Conclusion: The inference of the study shows that tumescent anaesthesia (0.1% lignocaine with adrenaline) has certain benefits when used as local anaesthesia for doing and repairing episiotomy when compared to 2% lignocaine in terms of prolonging duration of analgesia, reducing the time taken to suture episiotomy wound by demarcating the tissues which aids in easy suturing.

Puncture miniinvasive methods of surgical treatment of primary varicoses of the superficial veins of the lower extremities c2-c6s

Abstract. Treatment results of primary varicose disorders has been shown in article. The experience of using of thermal (endovenous laser ablation, radiofrequency ablation) and non-thermal methods (endovenous mechanochemical ablation, echo-controlled introduction of bioglue) in treatment of stage C2-С6 chronic venous is shown. The purpose of this work is to evaluate the efficiency of endovenous ablation techniques. The treatment of 218 patients was analyzed. In the group of patients who underwent EVLA, reflux was detected in 2 cases at the follow-up after week. In our opinion, this is due to insufficient exposure of the laser irradiation using a single-ring type of light guide. To correct the detected reflux, a single injection of foam scleroterapy. Foam form (3%) was used. In the group of patients after RFA, inflow reflux was detected in 1 patient (5.2%), in other cases complete obliteration was observed (17 patients - 89.4%). In the group of patients with mechanochemical obliteration, recanalization was determined in 5 patients (19.2%) with control ultrasound after 1 month. It was corrected by carrying out the procedure of foam scleroobliteration. In the group of patients with the cyanoacrylate obliteration, inflow reflux was detected in 2 patients (14.2%) on examination after 1 month. The received results lead to conclusion, that endovenous laser coagulation of affected veins is a more reliable method of threatment and the gold standard. The advantage of non-thermal methods is the absence of thermal effects on the paravenous structures, respectively, patients have no pain during the procedure, increases comfort, and there is no risk of damage to the paravenous nerves. Another advantage of non-thermal techniques is no need to use of tumescent anesthesia, since only one puncture is required for the operation, which is comfortable for patients. The use of adhesive vein obliteration is justified in patients with signs of a short reflux duration and has an advantage for the patient due to the absence of the need for compression in the postoperative period. In our study, foam sclerotherapy was the method of choice for treatment correction, if necessary.

Progressive Lipodystrophy: topical laser treatment with Endolift® procedure using Eufoton® LASEmaR®1500 1470-nm wavelength

Lipodystrophies are a group of rare disorders of diverse aetiology characterised by variable body fat loss. The loss of body fat may affect nearly the entire body (generalised), only certain body regions (partial) or small areas under the skin (localised). Body fat loss can result from underlying genetic defects, autoimmune mechanisms, or drugs. Progressive lipodystrophy is a chronic, inflammatory, degenerative disease of the connective tissue. It leads to the blockage of the circulation and lymphatic drainage, followed by an accumulation of toxins, which promote hyperplasia of the fat cells. As a consequence, connective tissue rigidity promotes skin dimpling or orange skin. This study was designed to evaluate the efficiency of Endolift®, a novel minimally invasive outpatient laser procedure, for the treatment of Progressive Lipodystrophy. 30 women showing cellulite, in the range of 20 to 55 y-o, were enrolled for this study. Patients have undergone a single treatment under tumescent anaesthesia. Treatment was performed using the Endolift® procedure, consisting of the device Eufoton® LASEmaR® 1500. In addition, a 1470-nm wavelength laser was utilised, lead by micro-optical fibres of different calibres directly inside the skin. This treatment aims to destroy and remove degenerative connective tissue and promote neocollagenesis. Optimal results were obtained by 23 patients, 5 had good results, and 2 reported moderate results. No side effect was recorded. Adipocytolysis was performed on 6 patients and we removed 50 to 350 ml of fat. Even after 3 years, 80% of patients maintain significant results. These data show that Endolift® laser treatment represents one of the most effective treatments for removing Progressive Lipodystrophy.

Hidradenitis suppurativa: interstitial laser treatment with Endolift® procedure using Eufoton® LASEmaR®1500 1470-nm wavelength

Hidradenitis suppurativa, also known as acne inversa, is a chronic inflammatory skin disease which affects ~1% of the world population. Hidradenitis suppurativa significantly impacts patients’ quality of life due to its chronic nature and frequently occurring relapses. Therefore, Hidradenitis suppurativa patients need to get an early diagnosis. This study was designed to evaluate the efficiency of Endolift®, a novel minimally invasive outpatient laser procedure, for treating Hidradenitis suppurativa. Thirty patients in the range of 19 to 43 y-o, 20 women and 10 men, were enrolled on this study. Patients have undergone a single treatment under tumescent anaesthesia. Treatment was performed using the Endolift® procedure, consisting of the device Eufoton® LASEmaR® 1500. This device uses a 1470 nm wavelength laser lead by micro-optical fibres of different calibres directly inside the skin. This treatment aims to destroy problematic glands with a thermal effect and remove them with liposuction. The treatment has a strong anti-inflammatory effect and promotes neocollagenesis. Eighteen patients obtained optimal results, 5 had good results, and 7 reported moderate results. The treatment was repeated for 7 patients for small refractory areas. Patients with earlier onset of the disease generally had better results. No side effect was recorded. Endolift® treatment represents a big hope for the patient because it is a safe, effective, minimally invasive procedure and can be repeated.

Integrating the Fast-Track surgery concept into the surgical treatment of gynecomastia

Background: The use of fast-track surgery pathway has been reported to reduce the stress of operation and accelerate rehabilitation in various surgical specialties. However, there has been a relative dearth of research on this subject for surgical treatment of gynecomastia. Materials and methods: The gynecomastia was treated by liposuction plus pull-through technique. The safety and recovery profiles were retrospectively compared between the patients in a standard pathway (including general anesthesia and postoperative drainage) and those in a fast-track pathway (including patient education, local tumescent anesthesia, no drainage, and effective pain control). Registered outcomes included postoperative complications, time to normal life, length of stay, patient satisfaction, etc. Results: From October of 2017 to October of 2021, 126 gynecomastia patients with Simon’s grade I or II who underwent the surgical treatments were included in the study, of which 25 patients were treated according to standard pathway, and 101 patients underwent the fast-track pathway. During the follow-up, there was no difference between the cohorts in the incidence of postoperative complications. Both the time to normal life and length of stay significantly decreased to 0 after the introduction of fast-track pathway. Overall, 94.1% of the patients ranked the fast-track surgical pathway as ‘great’ or ‘moderate' at the 3-month follow-up. Conclusions: The proposed fast-track pathway is feasible for surgical treatment of gynecomastia, leading to an enhanced recovery and high patient satisfaction without increasing the rate of complications. The fast-track surgery concept with implementation of local anesthetic techniques should be given serious consideration in gynecomastia management.

Bipolar Radiofrequency-Assisted Liposuction for Cervical Contouring in Eastern Asians.

East Asian beauty standards uphold a V-shaped face and a long slender neck. Some patients are dissatisfied with the concurrent nonsurgical treatment and prefer limited downtime with minimally invasive procedures to achieve a natural skin-tightening outcome. The authors performed bipolar radiofrequency-assisted liposuction (RFAL) to achieve cervical rejuvenation. To evaluate the efficacy and safety of RFAL for the treatment of cervical skin and soft-tissue laxity in Eastern Asians. In total, 66 patients with neck skin and soft-tissue laxity were treated with bipolar RFAL under tumescent local anesthesia. Further, the surgical outcomes were evaluated based on patient satisfaction score and the Global Aesthetic Improvement Scale (GAIS) score at 6 months postoperatively. Moreover, the incidence of postoperative complications was determined. All patients were followed up for at least 6 months. After RFAL technologies treatment, significant improvement in the neck contour was observed. The average GAIS score was 3.03 (4, very much improved; 3, much improved; 2, improved; 1, no change; and 0, worsened). Approximately 93% of patients were satisfied with the RFAL neck contouring outcome. Notably, no serious complications requiring further intervention were encountered in this series. The described RFAL treatment significantly improved the refinement of neck contouring in Eastern Asian subjects. The simple, minimally invasive cervical procedure under local anesthesia improve the cervical-mental angle definition, tissue-tightening effect, face slimming, and the mandibular line. No serious adverse events except mild complications were reported. This treatment could achieve extraordinary results with a high safety profile.

Early results of cyanoacrylate adhesive ablation versus laser ablation for the treatment of great saphenous vein insufficiency in the Chinese mainland population.

In this study, we present our early outcomes of cyanoacrylate ablation (CA) versus endovenous laser ablation (EVLA) for the treatment of great saphenous vein (GSV) insufficiency in the Chinese mainland population. We retrospectively analyzed 108 patients (53 patients in the CA group and 55 patients in the EVLA group) with GSV insufficiency who were treated with CA and EVLA between May 2020 and May 2021. The Venous Clinical Severity Score and Aberdeen Varicose Vein Questionnaire were used to assess clinical symptoms and quality of life, respectively. Total closure rates and procedure-related adverse events were also recorded in both groups. There was no significant difference between patients treated with CA or EVLA in terms of demographic and clinical characteristics. The average procedure time was 17min in the CA group and 35min in the EVLA group (p < 0.001). The CA group had lower pain scores during the procedure and 3days afterward than the EVLA group (p < 0.001). At month 12, the CA group had a 90.4% closure rate, while the EVLA group had an 83.0% closure rate, with no significant difference between the two groups (p > 0.05). There was no significant difference in the Venous Clinical Severity Score or Aberdeen Varicose Vein Questionnaire score between the groups (p > 0.05). During follow-up, neither group experienced any significant adverse events, such as pulmonary embolism or deep venous thrombosis. The incidence of ecchymosis and paresthesia was significantly lower in the CA group than in the EVLA group (p < 0.05). Cyanoacrylate ablation has a high feasibility profile and is an effective approach to accomplish complete GSV target vein closure at early follow-up in the Chinese patients. Compared to EVLA, the improvement in quality-of-life outcomes is also sustained and similar, with less pain and fewer complications due to the absence of tumescence anesthesia and postprocedural compression stockings.

Application of Femoral Nerve Block in Treating Great Saphenous Vein Insufficiency by Endovenous Radiofrequency Ablation Combined with Punctate Stripping.

To evaluate the efficacy and safety of ultrasound-guided femoral nerve block (FNB) in treating great saphenous vein (GSV) insufficiency by endovenous radiofrequency ablation (EVRA) combined with punctate stripping (PS). This was a single-center, retrospective cohort study. A total of 135 patients were divided into Group A (59 patients) and Group B (76 patients). All patients received tumescent anesthesia during the operation, and group A received an additional ultrasound-guided FNB before the procedure. Intraoperative and postoperative pain score, the volume of tumescent anesthesia solution (TAS), and other indicators were compared in two groups. Group A had a significantly lower intraoperative pain visual analog scale than group B (2.7 ± 1.2 vs 5.2 ± 1.5, P < 0.001). The volume of TAS in group A was significantly lower than that in group B (198 ± 26.6 ml vs 338 ± 34.7 ml, P < 0.001). Postoperative muscle strength of group A was significantly decreased compared with group B (54.2% vs 3.90%, P < 0.001); no patient had severe limitation of active movements in both groups, and all motor blocks recovered within 24 h. The incidence of skin ecchymosis in group A was lower than that in group B (18.6% vs 46.1%, P = 0.001). The operation duration of the two groups had no statistically significant difference. Ultrasound-guided FNB in treating GSV insufficiency by EVRA combined with PS significantly relieved intraoperative pain and reduced the dosage of TAS and the incidence of skin ecchymosis without increasing the complications of anesthesia or any other surgical complications.

Thoracic Interfacial Plane Block Versus Thoracic Paravertebral Block for Anesthesia in Gynecomastia Surgery

Background: Gynecomastia is a benign proliferative condition affecting the glandular tissue of the male breast. This study compared the efficacy of ultrasound-guided thoracic interfacial plane block (TIPB) with ultrasound-guided thoracic paravertebral block (TPVB) in providing anesthesia for gynecomastia surgery. Materials and Methods: This prospective randomized open label clinical trial included 90 patients scheduled for elective surgery for idiopathic gynecomastia. Patients were randomly allocated into three equal groups: group C (control group) received bilateral tumescent local anesthesia, group TPVB received bilateral ultrasound guided TPVB, and group TIPB received bilateral ultrasound guided TIPB. We evaluated postoperative analgesic requirements, pain score, and patient’s satisfaction. Results: Intraoperative fentanyl requirement and total diclofenac in the first 24 hours postoperative were significantly lower in both TPVB and TIPB groups compared to control group (P = 0.002 and P &lt; 0.001, respectively). Patient satisfaction was significantly better (P = 0.004) in both TPVB and TIPB groups when compared to control group. In postoperative evaluation, we found both TPVB and TIPB produced significantly lower pain score compared to control group in 2-hours (P &lt; 0.001) and 4-hours (P = 0.001) after the surgery. Mean arterial blood pressure, heart rate, and peripheral oxygen saturation were comparable in all groups, as well as the occurrence of complications. Conclusion: Either TIPB and TPVB may provide effective analgesic property for anesthesia in gynecomastia surgery. This is shown by lower intraoperative analgesic requirements, lower postoperative pain score, and better patient’s satisfaction.

MANAGEMENT OF MINIINVASIVE TREATMENT OF PRIMARY VARICOSE SUPERFICIAL VEINS.

The aim: Determination of the optimal method for surgical correction of stages C2-C6s varicose superficial veins. Materials and methods: The treatment results of 228 patients with stages C2-C6 of primary varicose according to the CEAP classification using thermal and non-thermal treatment methods were analyzed. Results: All patients underwent operations under the control of ultrasound scanning. In patients after EVLA, total trunk obliteration was detected in 148 patients (98.7%) after 1 week, and in 100% after a year. In 2 patients, reflux was diagnosed in the PDSV and in the ZDSV after 1 week. In patients after RFA, inflow reflux on the leg was in 1 patient (5.2%), in others - complete obliteration (18 patients - 94.7%). In patients after MOCA, recanalization was performed in 5 patients (19.2%) with a control ultrasound investigation after 1 month. In patients after cyanoacrylate obliteration, inflow reflux on the leg after 1 month was in 2 patients (14.2%). In patients who underwent UGS of the GSV trunk, 5 patients (33.3%) had persistence of pathological reflux after 1 month with control ultrasound. All corrections were performed using Foam form sclerotherapy. Conclusions: EVLA is the most effective method of treating varicose veins and gives the best long-term results. The advantage of non-thermal methods is the lack of influence on paravenous structures and no need for tumescent anesthesia, which is important in case of an allergic history. After applying cyanoacry¬late, there is no need for mandatory compression. The advantage of foam scleroobliteration is its lowest cost among all methods. Foam sclerotherapy was the method of choice for correction of postoperative treatment.