Use Of Tumescent Anesthesia Research Articles

Laser-sclerosing foam hybrid treatment, a non-tumescent technique for insufficient great saphenous vein ablation.

We aim to report on the Laser-Sclerosing Foam Hybrid Treatment (LSFHT) and its outcomes when used on patients with great saphenous vein (GSV) insufficiency. This was a single center retrospective cohort study on patients with GSV insufficiency that were treated with the LSFHT technique, a surgical procedure that comprises the use of both sclerosing foam and endovenous ablation and avoids the use of tumescent anesthesia. Occlusion rates and complications were reported. 139 legs from 106 patients were operated, achieving a 100% occlusion rate, while only a small burn and 2 popliteal vein thrombosis cases occurred. The study suggests that the LSFHT is a feasible fast procedure that proved both effective and safe for the treatment of GSV insufficiency.

Tumescent anesthesia use for cutaneous malignancies does not impact sentinel node identification but decreases estimated blood loss

Sentinel node biopsy is performed to stage clinically and radiographically occult regional disease in cases of malignancy, including cutaneous cancer such as melanoma. The use of tumescent anesthesia with sentinel node biopsy for cutaneous malignancies has not been well studied. Therefore, we aimed to compare the rate of successful sentinel node identification and estimated blood loss between patients who underwent sentinel node biopsy with and without the use of tumescent anesthesia. A retrospective review was conducted of a prospectively maintained single-institution database of all patients who underwent reconstruction after the extirpation of a cutaneous malignancy over an 18-month period. Patient demographics, tumor histology, and characteristics, indication for and success of sentinel node biopsy, use of tumescent anesthesia, and total estimated blood loss were examined. Sentinel node biopsy was performed in 15 of 39 patients (38.5%) receiving tumescent anesthesia compared with 6 of 26 patients (23.1%) not receiving it (p=0.19). Sentinel node biopsy had a success rate of 100% in the tumescent and nontumescent anesthesia groups. The mean estimated blood loss in the tumescent anesthesia group was 36.7mL versus 59.6mL in the nontumescent anesthesia group (p<0.001). Complication rates were comparable between the tumescent anesthesia (12.8%) and nontumescent anesthesia (19.2%) groups (p=0.48). The use of tumescent anesthesia in cutaneous malignancy extirpation and immediate reconstruction was not associated with a decreased sentinel node identification rate or change in complication rates. However, tumescent anesthesia was associated with a decrease in the estimated blood loss.

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.

Closure of defects in a geometric figure pattern associated with tumescent anesthesia with lidocaine in rabbits (Oryctolagus cuniculus)

Abstract The use of tumescent anesthesia with lidocaine can provide better intra- and postoperative analgesia that would benefit extensive reconstructive surgery. However, lidocaine can interfere with the healing process. Therefore, this study aimed to assess the local interference of the healing of induced and closed skin defects in a geometric pattern associated with the use of tumescent anesthesia with lidocaine in rabbits. Furthermore, we assessed its influence on cardiorespiratory parameters and postoperative analgesia. This study included 27 rabbits divided into three groups: GC (without the use of tumescence), GS (use of tumescence with 0.9% NaCl solution), and GL (use of tumescent anesthesia with lidocaine). There was no statistically significant intergroup difference in any stage of the wound healing process on macroscopic evaluations, in the angiogenesis process, or in the process of collagenization and fibroblast deposition. There were significant differences in heart rate (lower in GL), respiratory rate (higher in GC), mean arterial pressure (higher in GL), and expired concentration of isoflurane (lower in GL). There was no significant intergroup difference in the von Frey filament test or the visual analog scale score used to evaluate postoperative analgesia. We concluded that tumescent anesthesia with lidocaine does not impair postoperative tissue repair. Its use features benefits such as reducing the volume of inhaled anesthetic, maintaining the anesthesia plan, stable heart and respiratory rates, and lower hypotension during the surgical procedure.

THERMAL AND NON-THERMAL METHODS OF TREATMENT OF PATIENTS WITH PRIMARY VARICOSЕ DISEASES OF THE LOWER LIMBS OF STAGE C2

Abstract. Treatment results of primary varicose disorders has been shown. The experience of using of thermal (endovenous laser ablation) and non-thermal methods (endovenous mechanochemical ablation, echo-controlled introduction of bioglue) in treatment of stage C2 chronic venous is shown. The purpose of this work is to evaluate the efficiency of endovenous ablation techniques. The treatment of 58 patients was analyzed. In the group of patients who underwent endovenous laser obliteration, reflux was not detected. In the group of patients with mechanochemical obliteration, reflux was determined in 3 patients (27.2%) at follow-up after 3 months required supplementation with foam sclerobliteration. In the group of patients with the introduction of bio glue, reflux was determined in 1 patient (20%) at the examination after 3 months. The received results lead to conclusion, that endovenous laser coagulation of affected veins is a reliable method of threatment, 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. Non-thermal methods require further research and widespread implementation in practice.

Use of Tumescent Anesthesia in Surgical Excision of Gynecomastia.

Background. Gynecomastia, benign enlargement of the male breast is the most common breast pathology amongst males. The most widely used modality of treatment is liposuction under general anesthesia. To date however there is no published study that specifically addresses to use tumescent anesthesia & use of tranexamic acid in it for excision of gynecomastia. Objective. To evaluate the efficacy of tumescent anesthesia in surgical excision of gynecomastia. Methods. A 4-year study with 100 patients of gynecomastia aged 14 to 47 years were enrolled with follow up for 3 months. All patients were given tumescence anesthesia in each breast comprising subcutaneous infiltration of 500 ml RL, 20 ml 0.5% bupivacaine, 30 ml 2% lignocaine, 1 mg adrenaline & 1 gm tranexamic acid. Breast tissue was excised in each breast by a single infraareolar incision & patients were assessed for intra-op pain and post-op pain by using numeric rating scale (NRS). Results. Bilateral presentation was there in 69 patients and 31 unilateral with 4 recurrent cases. Size of gland excised were 12-14 cms in 53 cases, 15-18 cms in 38 & 19-20 cms in 9 patients. Average surgical time required for each breast was 30 minutes. Intraoperative pain NRS-0 for 66, NRS-1 for 31 & NRS-5 for 03 patients. Postoperative pain for first eight hours was NRS-0 for 69 and NRS-1 for 31 patients. Conclusion. Tumescent anaesthesia for surgical excision of gynecomastia using a periareolar incision is a minimally invasive bloodless and painless technique in which ductal and stromal tissue can be removed resulting in a high level of patient satisfaction. In todays covid era it avoids the use of general anesthesia and electrocautery.

Three-year follow-up results of the prospective European Multicenter Cohort Study on Cyanoacrylate Embolization for treatment of refluxing great saphenous veins

ObjectiveCyanoacrylate closure of refluxing saphenous veins has demonstrated excellent safety and effectiveness results in feasibility and pivotal studies. This article provides the 36-month follow-up results of a prospective, multicenter, nonrandomized cohort study. MethodsA total of 70 patients were enrolled in a prospective, multicenter study conducted at seven centers in four European countries and underwent treatment of a solitary refluxing great saphenous vein with endovenous cyanoacrylate embolization without the use of tumescent anesthesia or postprocedure compression stockings. The primary effectiveness end point was freedom from recanalization (closure rate) of the great saphenous vein at 6 months. Safety was assessed by occurrence of adverse events after the procedure and during the 6-month follow-up period. Quality of life and clinical improvement parameters were measured before and after the procedure and through a 12-month follow-up period. Anatomic success and clinical improvement were assessed through 36 months after the procedure. ResultsOf 70 treated patients, 64 (91%) were available for the 3-year follow-up. The closure rates by Kaplan-Meier life table methods at 6-, 12-, 24-, and 36-month time points were 91.4%, 90.0%, 88.5%, and 88.5%, respectively. Through 36 months, the improvement in change of the mean venous clinical severity score over time was statistically significant by dropping from 4.3 at baseline to 0.9 at the 36-month follow-up (P < .001). ConclusionsThe 3-year follow-up results of the prospective, multicenter eSCOPE study demonstrated the continued anatomic and clinical effectiveness of cyanoacrylate embolization over an extended follow-up period.

Tumescent anesthesia for dermatosurgical procedures other than liposuction

Context:Tumescent local anesthesia is a form of local anesthesia, which is a technique in which a dilute local anesthetic solution is injected into the subcutaneous tissue until it becomes firm and tense. Originally developed to facilitate liposuction, the use of tumescent anesthesia has expanded to other dermatological and plastic surgery procedures, as well as to other disciplines, including endocrine and vascular surgeries. For infiltration local anesthesia, the conventional dosage of lidocaine is up to 4.5 mg/kg, and that with adrenaline is up to 7 mg/kg; however, in liposuction using tumescent anesthesia, the recommended maximum dose of lidocaine with adrenaline is up to 55 mg/kg. There are several important pharmacological, pharmacokinetic, and pharmacodynamic factors that need to be considered in the administration of tumescent anesthesia leading to considerable interdisciplinary differences of opinion with respect to the maximum dose of local anesthetic permissible. Although several studies and publications have studied these issues in liposuction extensively, the role of tumescent anesthesia in other indications has not been reviewed adequately.Aims and Objectives:The aim of this study was to discuss the science behind tumescent anesthesia, its applications, and safety considerations in different dermatosurgical procedures other than liposuction.Materials and Methods:For this review, a systematic literature search in PubMed, Embase, Web of Science, Cochrane Library, Central, Emcare, Academic Search Premier, and ScienceDirect was conducted for safety studies on tumescent anesthesia.Conclusion:Tumescent anesthesia is generally very well accepted by patients and is relatively safe at the recommended doses. Nonetheless, one must be vigilant about the signs and symptoms of LAST, as they may not manifest until several hours after the procedure. Lipid emulsion therapy should be readily available and could prove life-saving in such situations.

Non-thermal endovenous treatment: acrylate adhesion of varicose saphenous veins

SummaryEndovenous treatment of varicose veins, especially thermal procedures using laser and radio frequencies, has become established as an effective alternative to surgery by stripping and high ligation. Although these methods are very sparing and patient-friendly, they also entail risks and side effects. The risk of damage to peripheral and motor nerves is certainly lower than with open surgery, however it still exists as a result of heat application and tumescent anaesthesia.Several non-thermal procedures which do not require the use of tumescent anaesthesia are coming onto the market. They carry a significantly lower risk of nerve lesions while remaining highly effective. The present work analyses the current state of knowledge on the latest to be developed, cyanoacrylate adhesion of incompetent saphenous veins.

On Beyond Lidocaine: Reconsidering Local Anesthetics in Tumescent Liposuction-A Critical Review.

The use of tumescent solution in liposuction is now considered standard of care; however, much debate still exists regarding its ideal components, especially surrounding the inclusion of local anesthetics. This article reviews the discussion regarding the use of local anesthetics in tumescent liposuction and how it may evolve in the future. The need for local anesthetic additives in tumescent liposuction has been questioned, and the use of longer-acting agents discouraged; however, increasing number of reports in recent years have described the increasingly widespread use of tumescent anesthesia where a wetting solution is infiltrated to achieve anesthesia in an operative field for procedures other than liposuction. More high-level evidence, such as randomized controlled clinical trials, will be required; however, it should be possible to develop a useful standardized algorithm that can guide surgeons to optimize patient safety as well as patient experience.

The European multicenter cohort study on cyanoacrylate embolization of refluxing great saphenous veins.

Cyanoacrylate (CA) embolization of refluxing great saphenous veins (GSVs) has been previously described. The outcomes from a multicenter study are still lacking. A prospective multicenter study was conducted in seven centers in four European countries to abolish GSV reflux by endovenous CA embolization. Neither tumescent anesthesia nor postinterventional compression stockings were used. Varicose tributaries remained untreated until at least 3 months after the index treatment. Clinical examination, quality of life assessment, and duplex ultrasound evaluation were performed at 2 days and after 1, 3, 6, and 12 months. In 70 patients, of whom 68 (97.1%) were available for 12-month follow-up, 70 GSVs were treated. Two-day follow-up showed one proximal and one distal partial recanalization. Three additional proximal recanalizations were observed at 3-month (n = 2) and 6-month (n = 1) follow-up. Cumulative 12-month survival free from recanalization was 92.9% (95% confidence interval, 87.0%-99.1%). Mean (standard deviation) Venous Clinical Severity Score improved from 4.3 ± 2.3 at baseline to 1.1 ± 1.3 at 12 months. Aberdeen Varicose Vein Questionnaire score showed an improvement from 16.3 at baseline to 6.7 at 12 months (P < .0001). Side effects were generally mild; a phlebitic reaction occurred in eight cases (11.4%) with a median duration of 6.5 days (range, 2-12 days). Pain without a phlebitic reaction was observed in five patients (8.6%) for a median duration of 1 day (range, 0 -12 days). No serious adverse event occurred. Paresthesia was not observed. Endovenous CA embolization of refluxing GSVs is safe and effective without the use of tumescent anesthesia or compression stockings.

Tumescentless endovenous radiofrequency ablation with local hypothermia and compression technique

Modern surgical management of chronic venous insufficiency is possible since the development of catheter-based minimally invasive techniques, including radiofrequency ablation (RFA) and the application of colour Doppler sonography. RFA technology requires the use of tumescent anaesthesia, which prolongs the operating time. Instilling tumescent anaesthesia percutaneously below the saphenous fascia is the steepest part of the learning curve. In our study, we compared operative and postoperative results of tumescentless RFA and RFA with tumescent anaesthesia, to investigate the necessity of tumescent anaesthesia. A total of 344 patients with Doppler-confirmed great saphenous vein insufficiency underwent RFA between January and December 2012. Patients were divided into two groups according to anaesthetic management. Group 1 consisted of 172 patients: tumescent anaesthesia was given before the ablation procedure, and group 2 contained 172 patients: a local hypothermia and compression technique was used; no tumescent anaesthesia was administered. The visual analogue scale (VAS) was used and ecchymosis scores of the patients were recorded. Clinical examinations were performed at each visit and Doppler ultrasonography was performed in the first and sixth month. Mean ablation time was significantly lower in group 2 compared to group 1 (7.2 vs 18.9 min; p < 0.05). Skin burn and paresthesia did not occur. The immediate occlusion rate was 100% for both groups. No significant difference was found between the groups in terms of VAS and ecchymosis scores. All patients returned to normal activity within two days. The primary closure rate of group 1 was 98.2% and group 2 was 98.8% at six months, and there was no significant difference between the groups (p > 0.05). Eliminating tumescent infusion is a desirable goal. Tumescentless endovenous RFA with local hypothermia and compression technique appears to be safe and efficacious. Our technique shortens the operation time and prevents patient procedural discomfort.

A Comparative Study of the Efficacy of Endovenous Laser Treatment of the Incompetent Great Saphenous Under General Anesthesia with External Air Cooling with and Without Tumescent Anesthesia

This clinical study reports our experience with endovenous laser treatment (ELT) in which external air cooling is used without classic tumescent anesthesia. Two hundred thirty-two patients underwent ELT under general sedation. In group A (n=192), ELT was performed with air cooling but without the concurrent use of tumescent anesthesia. In group B (n=40), patients were treated using the traditional tumescent technique. The parameters were similar for both groups: 980-nm diode laser, power of 15W, and pulse duration of 1second. The laser fiber and catheter were manually withdrawn in 3-mm increments. Ultrasound was performed to reevaluate vein closure at the end of surgery and 2 and 8weeks and 1year after. During follow-up, complications such as burns, dyschromia, pain, and dysesthesia, as well as time used for surgery were recorded. A 96% closure rate was obtained in groups A and B at 2 and 8 weeks. This rate remained stable 1 year after the ELT procedure. Except for a higher percentage of ecchymoses in group B (55%) than in group A (0%) (p<0.001), no significant differences were observed for complications. With external air cooling, ELT took 17.5minutes to perform for the whole leg, compared with 38.5minutes when using tumescent anesthesia (p<0.05). ELT surgery for the great saphenous vein can be safely performed using the air cooling method and is as efficacious as ELT done with tumescent anesthesia but takes significantly less time to perform.

Comment to: Mechanochemical tumescentless endovenous ablation: final results of the initial clinical trial, by Elias S, Raines JK. Phlebology 2012;27:67-72.

A new mechanochemical device, (ClariVeinw, Madison, CT, USA), that does not require a generator or the use of tumescent anesthesia, was developed to achieve venous occlusion utilizing a wire rotating within the lumen of the vein at 3500 rpm that abrades the intima to allow for improve the efficacy of the sclerosant. A liquid sclerosant (sodium tetradecyl sulphate) is concomitantly infused through an opening close to the distal end of the catheter near the rotating wire. The wire tip is positioned 2 cm from the saphenofemoral junction under ultrasound guidance. With the wire rotating and during sclerosant infusion, the catheter is pulled down the vein at a rate of approximately 1–2 mm per second. Catheter wire rotation is first activated for 2–3 s at the highest speed setting to create venospasm which minimizes forward flow into the common femoral vein. This is a single-use device that can be inserted through a 4 or 5 French guiding catheter with local insertion site anesthesia only, without the need for tumescence anesthesia. The system includes an infusion catheter, motor drive, stopcock and syringe....

Use of tumescent anaesthesia in dermatological surgery

Use of tumescent anaesthesia in dermatological surgery

Reducción del tiempo quirúrgico y de las complicaciones en el tratamiento endovascular con láser

Introduction In recent years there have been significant advances in the use of endovenous laser in the treatment of varicose pathology. This technique is performed by prior application of tumescent anesthesia in the whole area to treat and then inserting a laser fiber inside the saphenous vein provoking its thermal occlusion. The advantages of this technique is that it does not require general or spinal anesthesia, has a short intervention time, and is better tolerated by patients. Objective To reduce operating time of this technique without changing its efficacy and effectiveness, we used a method of perivenous tissue protection through the application of external cold, thus avoiding the use of tumescent anesthesia. Methods We have treated a total of 12 patients. In all, basal temperature was recorded before treatment and during laser discharge. We also recorded the average surgical time and complications. Results The average baseline temperature before laser discharge was 33 °C, with an average of 40 °C during laser treatment. In terms of surgical time, an average of 30 minutes was achieved. There were no treatment-related complications. Finally, in the follow-up to one year, total occlusion of saphenous vein was demonstrated in all patients. Conclusion The application of our method of perivenous saphenous tissue protection can shorten the operating time of laser treatment.

Mechanical-Chemical Endovenous Ablation: A New Tumescentless Technique

The minimally invasive management of vein disease continues to evolve. Endothermal methods to ablate the great and small saphenous veins involve the use of tumescent anesthesia for analgesia and compression with possible adjunctive intravenous sedation. Foam sclerotherapy of the great and small saphenous veins has been attempted with mixed results. A new endovenous device that does not require tumescent anesthesia or intravenous sedation, ClariVein® (Vascular Insights LLC, Conn), was evaluated. The ClariVein® catheter utilizes endovenous mechanical vein wall destruction with a rotating wire and the simultaneous infusion of a liquid sclerosant (Sotradecol®) to enhance venous ablation. This endovenous mechanical treatment is unique. This Institutional Review Board-sanctioned study evaluated the safety and efficacy of this technique. The ClariVein device was utilized in 30 patients with great saphenous vein incompetence. All procedures were performed in office with only local anesthesia at the access site. No tumescent anesthesia or intravenous sedation was employed. Ultrasound guidance similar to other endovenous procedures was used. Post treatment care was similar to endovenous thermal ablative procedures. Total procedure time was less than 15 minutes. Access was at the lowest level of incompetence but no lower than below the knee. Results at one week, one month, and three months will be presented including occlusion rates greater than 90%. Complication rates and symptom resolution will be discussed. The unique endomechanical ablative aspect of the ClariVein coupled with a safe FDA approved liquid sclerosant represents a further simplification and advancement in the treatment of venous disease. This is accomplished without the tumescent anesthesia currently required for endothermal methods and an early success rate comparable to these methods.

Surgical pearl: Tumescent anesthesia reduces pain of axillary laser hair removal

BACKGROUND We describe the use of tumescent anesthesia before laser hair removal in the axilla to improve patient comfort during treatment. Our modified tumescent technique provides more extensive anesthesia than standard intradermal injections of local anesthetic agents and is less painful to administer. Compared with topical anesthetic creams, tumescent anesthesia has a quicker onset and delivers more complete anesthesia. Hair removal by laser or intense pulsed light sources is a painful procedure, especially in sensitive areas such as the beard, axilla, and groin. Recent trends in laser hair removal (longer pulse durations and wavelengths) offer better treatment of dark skin, 1 but are even more painful. Topical anesthetic creams are commonly used to decrease discomfort, butareslow toactandcan bemessy. 2 Wehavefound that axillary injection of tumescent anesthesia is extremely effective for reducing the discomfort of laser hair removal. In addition, the pain of injection into the subcutaneous fat is minimal (compared with thedermis)and,therefore,welltolerated bypatients. The technique is quick, safe, and cost-effective, making it an important tool in our practice for a wide variety of procedures, including laser hair removal.

Liposuction

Through the appropriate use of tumescent anesthesia and the use of modern instruments and techniques, liposuction surgery has become a low-risk procedure which produces predictable and aesthetically pleasing results. New indications for liposuction surgery include lipedema and cellulite. Vibration-assisted liposuction has proven to be especially gentle to the tissues. The induced tissue contraction helps to create better results in correction procedures after less-than-satisfactory liposuction. Autologous fat transfer is also firmly established as an augmentation procedure. In liporecycling, the fat obtained during reduction liposuction is used elsewhere for augmentation. New approaches in fat transfer include the microdroplet technique, flatter injection approaches and three-dimensional tissue augmentation.

Advances and controversies in face lift surgery.

The only constant in face lift surgery is the goal-rejuvenation of the lower two thirds of the face and neck. Societal shifts have focused patients on less invasive procedures, with less downtime and more rapid return to daily activities. The lateral SMASectomy procedure has proven to be an effective technique, with a high degree of safety, minimal morbidity, and high patient satisfaction. Additionally, younger patients often require less extensive procedures to achieve an aesthetically desirable result. Recent advances such as the short scar face lift with SMASectomy, and the S-lift, have centered upon less invasive approaches to lower face and neck restoration. The optimal technique for correction of platysma bands also remains elusive, with multiple options available. All procedures dramatically benefit from the use of tumescent anesthesia to decrease operative time, postoperative morbidity, and recovery time. There is no single ideal technique for each patient. The procedure used must be individualized for each patient's unique anatomy and goal for surgical restoration.