What is it about?

Lidocaine is a local anesthetic which has been increasing used as the primary source of anesthesia for vein procedures such as thermal saphenous vein ablations which treat the underlying cause of varicose veins and superficial venous insufficiency. The saphenous vein ablation is a modern less invasive replacement to vein stripping. The tumescent technique which uses large amounts of dilute lidocaine to create anesthesia was developed for liposuction and now is increasingly being used to replace general anesthesia for treatments of incompetent saphneous and varicose veins. Lidocaine is generally a safe medication but the safety of the large amount used for tumescent anesthesia has not been studied for these venous vascular procedures. Lidocaine safety and pharmacology has been studied for liposuction, but the absorption of the lidocaine is different around large veins. This paper reports on a study of the absorption and side effects of large doses of lidocaine when used for tumescent anesthesia.

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Why is it important?

Tumescent anesthesia is almost always safer for patients than general anesthesia. Tumescent anesthesia does not require the expensive continuous monitoring that general anesthesia requires and can be safely used in office and outpatient centers. These benefits allow tumescent anesthesia is now being used for more and more outpatient procedures, including varicose vein treatment that used to be done in hospitals. It is important that this anesthesia technique which was developed for liposuction and relies on relatively large doses of lidocaine be studied for safety and side effects when used to treat saphenous veins which when enlarged often cause varicose veins.

Perspectives

The dose of lidocaine used by almost all vein surgeons using tumescent anesthesia appears to be safe, however there are clearly limits. I think it is important to know where these limits are so that we can safely treat our patients.

Dr Thomas Wright
Laser Liposuction and Vein Center

Read the Original

This page is a summary of: Lidocaine safety after saphenous vein tumescent anesthesia, Phlebology The Journal of Venous Disease, March 2019, SAGE Publications, DOI: 10.1177/0268355519836834.
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