CARDIOVASCULAR JOURNAL OF AFRICA • Volume 33, No 2, March/April 2022 84 AFRICA The effect of different anaesthesia techniques on postoperative pain and hospital discharge in varicose vein surgery Mehmet Mutlu, Seray Turkmen Abstract Introduction: Venous insufficiency caused by varicose veins, especially in the lower extremities, is widespread and can cause severe complications. Anaesthesia is essential for any surgical approaches in varicose vein surgery. This study evaluated the effect of single-dose epidural anaesthesia on postoperative pain scores and length of hospitalisation after varicose vein surgery, comparing it with general anaesthesia. Methods: The study was conducted on a total of 100 patients, aged 18 years and older, with the American Society of Anesthesiologists (ASA) physical status classification I–III, undergoing unilateral lower-extremity stripping due to varicose veins within a six-month period at the Prof Dr Cemil Taşçioğlu City Hospital Anesthesiology and Reanimation Service. Fifty patients with single-dose epidural anaesthesia were consecutively included in the EA group. For comparison, 50 patients who were operated on under general anesthesia were included in the GA group. Results: The groups showed statistically significant differences between the 30th-minute and first-, second-, fourth- and sixthhour visual analogue scale (VAS) scores (p = 0.001; p < 0.01). Patients with epidural anaesthesia had lower 30th-minute VAS scores compared to those administered general anaesthesia. There were statistically significant differences identified between the groups for the additional analgesia requirements of patients (p = 0.001; p < 0.01). Subjects with epidural anaesthesia had lower additional analgesic requirements than those administered general anaesthesia. Conclusion: Epidural anaesthesia provided adequate anaesthesia with more effective postoperative analgesia compared to patients operated on under general anaesthesia and receiving multimodal analgesia for postoperative analgesia. Keywords: epidural anaesthesia, multimodal analgesia, stripping, varicose vein Submitted 1/11/21, accepted 16/11/21 Published online 30/11/21 Cardiovasc J Afr 2022; 33: 84–87 www.cvja.co.za DOI: 10.5830/CVJA-2021-061 Venous insufficiency caused by varicose veins, especially in the lower extremities, is prevalent and can cause severe complications.1 Today, rather than life-threatening complications, aesthetic and cosmetic issues caused by varicose veins have made treatment more popular, especially for women. This popularity has recently led to many new therapies apart from standard varicose vein surgery, such as stripping.2 Endovenous laser ablation, radiofrequency and foam sclerotherapy are recently described protocols for varicose veins that have replaced surgical treatment.3 Limited availability of non-invasive venous imaging methods causes surgery to be the only treatment option for many patients.4 For all new treatment interventions and surgeries, a substantial number of patients require general or regional anaesthesia.5 During surgery, sedation and regional anaesthesia techniques, different from classical anaesthetic approaches, are applied in parallel with minimally invasive surgical procedures to shorten the hospital discharge time, increase patient comfort and reduce postoperative pain.6 Despite the effective use of intravenous analgesics in patients operated on under general anaesthesia, severe postoperative pain delays discharge and causes serious movement restrictions in the postoperative period.7 Neuraxial anaesthesia allows surgery without unintentional movement of the patient’s arms or hands and includes postoperative analgesia, so it is preferable to general anaesthesia. However severe complications such as dural puncture and transient or permanent peripheral nerve injury limit the use of regional anaesthesia.8 Some patients undergoing regional anaesthesia often need sedation, depending on the patient’s level of anxiety.9 Single-dose epidural anaesthesia is used in many centres for patients with planned varicose vein surgery, both for surgical anaesthesia and because it provides long-term postoperative analgesia, as with other regional anaesthesia techniques.10,11 It causes fewer motor blocks, unlike peripheral blocks. It offers prolonged postoperative analgesia equivalent to peripheral block, and there is no risk of peripheral nerve damage.12 General anaesthesia is also routinely used in varicose vein surgery because it promotes early recovery. However, delayed mobilisation due to severe postoperative pain after general anaesthesia prevents early hospital discharge and prolongs hospitalisation.11,13 This study evaluated the effect of single-dose epidural anaesthesia on postoperative pain scores and hospitalisation after varicose vein surgery, comparing it with general anaesthesia. Methods The local ethics committee approved this prospective, observational study (date 08.01.2019, number 1081). After Department of Anesthesiology and Reanimation, Prof Dr Cemil Tascioglu City Hospital, Istanbul, Turkey Mehmet Mutlu, MD, drmmutlu@gmail.com Seray Turkmen, MD
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