Local anesthesia should be preferred in varicose vein treatments
WHICH ANESTHESIA IN VARICOSE VEIN TREATMENT?
Anesthesia is an important issue in the treatment of varicose veins. On the one hand, the patient should be free from pain and anxiety during the procedure, but on the other hand, the procedure should be at maximum safety. In spider vein treatments, pain is minimal and no anesthesia is required, as very thin needles are used superficially. In the treatment of large varices with venous insufficiency, anesthesia should be applied. The anesthesia methods that can be applied for this purpose are general anesthesia, spinal anesthesia, local anesthesia and nerve blockage.
General anesthesia and spinal anesthesia are normally used in classical open varicose vein surgery. Today, there are centers that apply these methods also in nonsurgical varicose veins treatments. The advantages of general or spinal anesthesia are that the patient does not feel any pain and the doctor can perform treatment without tumescent anesthesia (injection of local anesthetic around the vein). Therefore, physicians who do not have ultrasound experience and cannot perform tumescent anesthesia generally prefer these methods. However, general and spinal anesthesia have some risks and disadvantages for the treatment of varicose veins:
1. During and after varicose veins treatment, the patient remains immobilized for a very long time, which can lead to the formation of clots (deep vein thrombosis) in the veins.
2. Especially in thermal methods such as laser and radiofrequency, sensory nerves that are very close to the vessel may be damaged. If the patient is awake during the procedure, this damage can be recognized immediately and measures can be taken. However, if the patient is anesthetized fully or below the waist, nerve damage cannot be understood and measures cannot be taken.
3. General or spinal anesthesia is generally preferred to eliminate the need for tumescent anesthesia because physicians who do not have ultrasound experience cannot perform it. However, tumescent anesthesia is not only done to prevent pain, but there are two other important benefits besides pain relief: 1. In laser or radiofrequency, the tumescent fluid given around the vein protects the surrounding tissue from heat damage, 2. This fluid empties the vein causing the blood to go into other veins. In this way, both the laser and radiofrequency are more effective to the vein surface, and since there is no blood in the vein, the risk of thrombophlebitis decreases. Therefore, in general and spinal anesthesia, the procedure is easier for the physician, but the patient is unable to take advantage of tumescent anesthesia.
4. In general and spinal anesthesia, the patient is exposed to the additional risks of these procedures.
5. General and spinal anesthetics increase the cost of treatment and can only be performed in a hospital setting.
As a result, general or spinal anesthesia methods may be advantageous for some doctors and hospitals, but have disadvantages and risks for patients, so they are not ideal for the treatment of varicose veins.
Local anesthesia is the most common form of anesthesia in venous insufficiency and varicose veins. In local anesthesia, some sedative medications are given first (sedation) to reduce the patient's anxiety and nervousness. Then, the skin is anesthetized, a laser or radiofrequency catheter is inserted into the vein and tumescent anesthesia is initiated. In tumescent anesthesia, ultrasound guided fluid with very fine needles is given a fluid containing local anesthetic is injected around the vessel with very fine needles. As mentioned above, this fluid not only relieves pain and protects the surrounding tissues, but also removes blood from the vein, increasing the effect of the procedure and reducing clot formation. During these procedures, the patient may experience minor pain similar to mosquito bites at the skin. Because the vessel is numbed all around, the patient does not feel anything during laser or radiofrequency. Since the patient is awake, he or she may move feet at regular intervals, thereby accelerating the blood flow in the veins and preventing the risk of clotting. Local anesthesia and tumescent anesthesia, when performed with care in experienced hands, is extremely comfortable and safe for the patient. Being awake during the procedure reduces the risk of nerve damage, the ability to make foot movements during treatment and to stand up early after treatment minimizes the risk of coagulation (deep vein thrombosis). Therefore, the first choice of anesthesia in the treatment of varicose veins is a "well" performed local + tumescent anesthesia.
In recent years, in some centers, nerve blocks have been performed in addition to local and tumescent anesthesia. These procedures are performed under ultrasound guidance and certain parts of the leg are completely numbed with a single injection, as dentists numb the jaw. In nerve blocks, either the femoral nerve in the groin or the sciatic nerve behind the thigh are anesthetized.