Effectiveness and safety of tumescent anesthesia in the comprehensive management of patients with chronic venous disease of the lower extremities

Aim. To improve the efficacy of analgesia and reduce the incidence of complications associated with tumescent anesthesia (ТА) during various stages of surgical interventions in patients with chronic venous disease (CVD) of the lower extremities by identifying the optimal technical parameters for its administration. Materials and Methods. A single-center, open-label, non-randomized, prospective study was conducted from 2019 to 2024 and included 591 consecutive patients with clinical manifestations of CVD (C2–C6 according to the CEAP classification). TA was administered using a modified Klein solution under continuous ultrasound guidance at a flow rate of 50 mL/min. The primary endpoint of the study was to evaluate the technical characteristics of TA and the effectiveness of the proposed technique for analgesia during radiofrequency ablation (RFA). The secondary endpoint was to assess the safety of TA and the incidence of complications. Results. A total of 620 lower extremities underwent RFA; 92.7% involved the great saphenous vein (GSV) and 7.3% the small saphenous vein (SSV). Concomitant miniphlebectomy was performed in 85.5% of cases. The mean volume of tumescent solution per centimeter of treated vein was 12.5 mL/cm for the GSV and 13 mL/cm for the SSV. No statistically significant differences were observed between procedures performed as isolated truncal ablation and those combined with miniphlebectomy; however, bilateral procedures demonstrated a statistically significant difference in solution volume (p < 0.05). The perioperative VAS score was 1.9 ± 1.7 cm for isolated RFA and 2.9 ± 1.8 cm for combined treatment with miniphlebectomy, with no significant differences between the groups. Pain scores decreased to 1.2 ± 1.3 cm within 48 hours and increased to 0.68 ± 1.1 cm on postoperative day 7. TA-related complications included ecchymosis in 15.8% of cases and transient paresthesia in 0.7%. No allergic reactions or thermal skin injuries were observed. Conclusions. The use of tumescent anesthesia with a modified solution and the proposed technique demonstrates a high safety profile and provides effective analgesia, enabling comprehensive treatment of patients with chronic venous disease of the lower extremities while avoiding the need for general or spinal anesthesia.