Rethinking Utilization of Tumescent Anesthesia in Venous Procedures

Objective Tumescent anesthesia, developed for liposuction procedures, is now routinely used in association with endovenous thermal ablation procedures. The use of "tumescent" has three aims: anesthetizing the perivascular area, applying hydrostatic pressure to collapse target veins and providing thermal insulation. Whereas tumescent anesthesia is delivered via long infiltration cannulas during liposuction surgeries, the common practice for venous ablations is to use spinal needles (typically 20-22 gauge). Although effective, long needles were not optimized for this indication for use and cannulas may offer certain advantages. Methods We report on the results of a 226 patient, retrospective study during which commercial (liposuction) infiltration cannulas were used to administer tumescent anesthesia. Chronological, de-identified patient data were extracted from past cases and summarized in a spreadsheet format. Results The results highlight several outcomes of note: very low adverse event reports and no reported nerve damage; low procedure durations; lower access due to effective hydrodissection and blunt dissection of the target vein. Additionally, the concentration of anesthetic used was 0.89+/-0.38 mg/kg for great saphenous vein (GSV) ablations and 0.34+/-0.18 mg/kg for small saphenous vein (SSV) ablations. We feel that a significant factor in the ability to use such low concentrations and total volumes is the completeness of hydrodissection and ability to stay within the investing fascia. Conclusion We propose that a purpose-built infiltration cannula to facilitate tumescent delivery during thermal ablation surgeries is a promising avenue for development. The clinical data presented comprise a first step in that direction.