Regional Anesthesia Methods Under Ultrasound Guidance for Endovenous Laser Ablation and Miniphlebectomy

Abstract

Comparative effectiveness of the combination of n. femoralis and n. ischiadicus fossa poplitea block with n. femoralis and n. saphenus block under ultrasound control in endovenous laser ablations and mini-phlebectomy.

Aim. To conduct a comprehensive comparison of two regional anesthesia techniques regarding their effectiveness, safety, and clinical feasibility in the minimally invasive treatment of lower extremity varicose veins.

Materials and Methods. A prospective randomized study was conducted involving 50 patients, divided into two groups: Group A (femoral and sciatic nerve block in the popliteal fossa, n = 25) and Group B (femoral and saphenous nerve block, n = 25). All procedures were performed under ultrasound guidance using 300 mg of 1 % lidocaine hydrochloride solution. Intraoperative pain (VAS scale), hemodynamic parameters, duration of motor block, and perioperative cortisol level dynamics were assessed.

Results. Group A demonstrated a significantly longer duration of anesthesia and motor block — 300.0 (180.0) minutes — and provided better analgesia of the posterior lower leg. In contrast, Group B was associated with a shorter duration of motor block — 220.0 (200.0–240.0) minutes. The level of intraoperative pain (VAS) showed no statistically significant differences between the groups. However, to achieve adequate analgesia, patients in Group B required higher doses of fentanyl compared to those in Group A.

Conclusions. Both methods are effective and safe options for anesthesia during EVLA and miniphlebectomy. The combination of femoral and saphenous nerve blocks is optimal for routine procedures due to its technical simplicity and shorter execution time. The combination of femoral and sciatic nerve blocks in the popliteal fossa is recommended for complex cases requiring prolonged analgesia. Ultrasound guidance ensures a high level of safety for both techniques.