[Peripheral nerve block during ambulatory surgery of varicose veins]

This retrospective study of the 46 operations, carried out over a one year period for lower limb varicose veins using peripheral nerve blocks, included 45 patients (35 women and 10 men, mean age 49.3 years), all ASA 1 or 2, except for 4 elderly patients with a varicose ulcer (ASA 2 or 3). In 40 procedures, a sciatic nerve block combined with a "3 in 1" lumbar plexus block at the level of the groin (as described by Winnie) were used. In the remaining six, either a sciatic nerve block (short saphenous vein crossectomy; n = 3), or a "3 in 1" lumbar plexus block alone (short stripping of the long saphenous vein; n = 3) were required. A peripheral nerve stimulator to locate accurately each nerve was used. For each nerve block, the anaesthetic mixture consisted of 20 ml lidocaine 1.5% with 1:200,000 adrenaline, and 10 ml of bupivacaine 0.375% with 1:200,000 adrenaline. Surgery was only performed on one limb at a time, as the required dose of local anaesthetic was too high to safely carry out bilateral nerve blocks. In 71.7% of patients surgery was made on an day-case basis. Of those patients who had to remain in hospital overnight or longer, the peripheral nerve block was never responsible for this. During the same period, nine similar procedures were carried out under general anaesthesia, and two under epidural anaesthesia. They included seven bilateral varicose veins, three patient refusals for peripheral nerve blocks, and one allergy to lidocaine. Already used for some procedures in orthopaedic and casualty surgery, peripheral nerve blocks seem to be well suited for surgery of unilateral varicose veins.