Tumescent anaesthesia for endovenous interventions - a survey of medical practitioners

BackgroundThe recent global shortage of sterile saline highlighted a lack of published information and guidance regarding the components used in tumescent anaesthesia (TA) for endovenous interventions of venous disease. The aim of this study was to identify current practices in the usage of TA.MethodsAn online survey was sent to members of the Australasian College of Phlebology and the mailing list of the International Union of Phlebology.Results87 medical practitioners either partially or fully completed the survey, with the majority of respondents being Phlebologists (54%). The vast majority of survey participants use lignocaine (92.5%), adrenaline (55%), sodium bicarbonate (67.1%) in a base fluid of sterile normal saline (90.8%) in the preparation of TA. The majority of administration was through mechanical pumps (68.1%), with 27.8% using syringes. 21.7% reported reusing the same tumescent bag for more than one patient. Only 36.2% obtained consent specifically for TA. Two thirds recorded the anaesthetic dose, as mg/kg (23.5%), or total dose (45.6%) Only 40.6% of participants reported storing intralipid. 7.9% of respondents in this survey had experienced Local Anaesthetic Systemic Toxicity, with one death reported.ConclusionsThe survey identified some variability in the volume of components used, and considerable variability in consenting practices, documentation, patient observations, the storage of Intralipid and the re-use of single use intravenous fluid bags between patients.