RU2842404C1 - Method of local anaesthesia with thermal methods of surgical treatment of varicose disease of lower extremities - Google Patents

Abstract

FIELD: medical science.

SUBSTANCE: invention refers to medicine, particularly to surgery. Paravasally administered is 0.9% normal saline in amount of 500 ml, cooled to +4 °C with the help of a cooling unit of a double-circuit infiltration dispenser.

EFFECT: method enables reducing a pain factor and avoiding the use of local anaesthetics in thermal surgical management of varicose disease of lower extremities.

1 cl, 2 ex

Description

The invention relates to the field of medicine, in particular to surgery, namely to methods of pain relief, and can be used in modern phlebological operations on the lower extremities.

Varicose veins of the lower extremities occur in 70% of women and 30% of men of working age, and, on average, the first signs of reflux in the lower extremities appear at 20–25 years of age. In Russia alone, more than 38 million people are officially registered as suffering from various forms of varicose veins, of which 15% have trophic disorders. [https://cyberleninka.ru/article/n/otsenka-rasprostranennosti-i-faktorov-riska-varikoznogo-rasshireniya-ven/viewer].

Currently, thermal methods of surgical treatment of varicose veins of the lower extremities, which include endovascular laser coagulation (EVLC) and radiofrequency ablation (RFA), prevail over standard phlebectomy performed under spinal anesthesia or general anesthesia. These thermal methods of surgical intervention are performed under local anesthesia. At the same time, up to 12% of people have an aggravated allergic history to local anesthetics (novocaine, lidocaine), so they refuse surgical intervention and do not seek medical help.

There are various methods of local anesthesia in operations on the subcutaneous main veins and their tributaries. A method of anesthesia by introducing the local anesthetic novocaine or lidocaine is known [Vishnevsky A.A. Anesthesia in surgery. Moscow, Meditsina, 1954]. At the same time, some patients experience side effects due to intolerance to these drugs in the form of allergic reactions, from banal urticaria to Quincke's edema and anaphylactic shock.

A method of pain relief in surgical treatment of varicose veins is known (Patent RU 2514337, published 27.04.2014), which consists in the fact that the treatment is carried out using endovascular laser coagulation of veins, a tumescent water "cushion" is created with a saline solution, after which the pathological vessel is affected by laser energy, and to create a tumescent water "cushion" a cold ozonized 0.1% lidocaine solution is used with a temperature of 5-7°C, an ozone concentration of 4-5 μg/ml and an ozone saturation time of 5-8 minutes.

The disadvantages of this method are the impossibility of further reducing the intensity of pain in patients with a low pain threshold or in the case of an expansion of the scope of surgical intervention, as well as the need for special equipment for ozonation of the anesthetic solution.

A method of pain relief in surgical treatment of varicose veins is known [https://patenton.ru/patent/RU2641860C1], including regional anesthesia, tumescent anesthesia, and echo-controlled conduction anesthesia of the femoral and/or sciatic nerves using a dosage of lidocaine of 40 mg, 200 mg, 400 mg depending on the individual characteristics of the patient and the scope of the operation. A solution for tumescent paravasal anesthesia is used in thermal methods of surgical treatment of varicose veins, in particular, in radiofrequency obliteration of subcutaneous veins [https://yandex.ru/patents/doc/RU2689300C120190527]. The technical result is based on the exclusion of adrenaline from the composition of the anesthetic solution.

The disadvantage of the last two methods listed above is the use of a local anesthetic - lidocaine, to which patients may have an allergic reaction.

The objective of the present invention is to create a simple, convenient, practical method of pain relief that eliminates the use of local anesthetics and at the same time significantly reduces the pain factor during operations in patients suffering from varicose veins of the lower extremities by paravasal administration of a 0.9% saline solution in a volume of 500 ml, cooled to +4°C using a cooling unit of a dual-circuit infiltration dispenser [https://patenton.ru/patent/RU2817479C1].

Thanks to the cooling unit, the temperature of the solution supplied along the vein decreases, creating a so-called "cold cushion", which allows vascular operations to be performed almost painlessly for the patient under local tumescent paravasal anesthesia. The principle of operation of the device is based on the use of the thermoelectric effect, or Peltier effect.

Example of practical use No. 1.

Patient A., 32 years old. Diagnosis: Chronic venous disease of the left lower limb C2,3,4S, Ep, As, Pr; 04/15/2024; LI. Chronic venous insufficiency grade II. The operation was performed on 04/15/24. Endovascular laser coagulation of the left small saphenous vein along its entire length, dissection of incompetent perforating veins of the left leg under local anesthesia (paravascular administration of 0.9% saline solution - 500 ml, cooled to +4°C using a cooling unit of a dual-circuit infiltration dispenser).

After processing the surgical field, a linear incision of up to 0.5 cm was made in the area of the source of the small saphenous vein on the left, a laser radial light guide was inserted into the proximal end of the vein under the control of ultrasound angioscanning, 2 cm from the saphenopopliteal anastomosis. Then tumescent paravasal anesthesia with the proposed solution was performed along the entire length of the small saphenous vein, and then endovasal laser coagulation of the small saphenous vein was performed. A suture was applied to the wound. Aseptic dressing. Compression hosiery of the II compression class. The postoperative period was uneventful. The patient stayed in the surgical department for 1 hour. He was discharged in a satisfactory condition on the day of the operation. The patient did not have any postoperative complications within 6 months.

Example of practical use No. 2.

Patient V., 47 years old. Diagnosis: Chronic venous disease of the right lower limb C2-4S, Ep, As, Pr; 04/15/2024; LI. Chronic venous insufficiency grade II. The operation was performed on 06/27/24. Endovascular laser coagulation of the great saphenous vein of the right lower limb along the entire length under local anesthesia (paravascular administration of 0.9% saline solution - 500 ml, cooled to + 4 ° C using the cooling unit of a dual-circuit infiltration dispenser).

After treating the surgical field, a linear incision of up to 0.5 cm was made in the area of the source of the right great saphenous vein, a laser radial light guide was inserted into the proximal end of the vein under the control of ultrasound angioscanning, 2 cm from the saphenofemoral junction. Then, tumescent paravasal anesthesia with the proposed solution was performed along the entire length of the great saphenous vein, and then endovasal laser coagulation of the great saphenous vein was performed. A suture was applied to the wound. Aseptic dressing. Compression hosiery of compression class II. The postoperative period was uneventful. The patient was in the surgical department for 30 minutes. She was discharged in a satisfactory condition on the day of the operation. The patient did not have any postoperative complications for 6 months.

The examples provided demonstrate the possibility of using the proposed method of local anesthesia in thermal methods of surgical treatment of varicose veins of the lower extremities.

The use of this method of pain relief allows eliminating the risk of using anesthesia, the possibility of using this method of local anesthesia in patients with a burdened allergological history, improves the quality of life and shortens the rehabilitation period.

Claims (1)

A method of local anesthesia in thermal methods of surgical treatment of varicose veins of the lower extremities by paravasal administration of 0.9% saline solution in a volume of 500 ml, cooled to +4°C using a cooling unit of a dual-circuit infiltration dispenser.