Less Painful Tumescent Solution for Patients Undergoing Endovenous Laser Ablation of the Saphenous Vein

Background: This study aims to investigate the efficacy of lidocaine, prilocaine, and bupivacaine used in tumescent solution during endovenous laser treatment (EVLT) on intraoperative and postoperative pain. Methods: This prospective randomized study included 90 patients. The patients were divided into 3 groups including 30 patients in each group, according to the content of local anesthetics in tumescent solution. All patients received EVLT treatment with lidocaine in group 1, prilocaine in group 2, and bupivacaine in group 3. Visual analog scale was used for the evaluation of intraoperative and postoperative pain. Results: The mean intraoperative pain score was 2.27 +/- 1.53 in group 1, 1.97 +/- 1.54 in group 2, and 3.05 +/- 0.73 in group 3. On the first day postoperatively, the mean pain score was 2.57 +/- 1.7 in group 1, 3.27 +/- 1.23 in group 2, and 1.13 +/- 0.94 in group 3 (P = 0.0001). Intraoperative and postoperative mean pain scores during first day follow-up were significantly lower in group 3. Conclusions: Tumescent anesthesia is the most critical component of EVLT to improve comfort by reducing the pain. Therefore, we conclude that bupivacaine is an optimal alternative to lidocaine and prilocaine in tumescent anesthesia and can be used safely.