UNASSIGNED: To compare the analgesic effects of specific tumescent anesthetic solutions composed of lidocaine, ropivacaine, or a combination of lidocaine and ropivacaine during endovenous radiofrequency ablation for the treatment of great saphenous vein varicosities.
UNASSIGNED: This study included 149 patients with lower limb varicose veins who were admitted to our department between 2019 and 2023. The patients were randomly assigned to three groups: the lidocaine group (Group I), the ropivacaine group (Group II), and the lidocaine + ropivacaine group (Group III). Intraoperative vital signs, intraoperative and postoperative visual analog scale (VAS) pain scores, and long-term treatment outcomes were assessed using the venous clinical severity score (VCSS) based on clinical performance.
UNASSIGNED: There were no significant differences in age, body mass index, operative time, or blood loss among the three groups (P ≥ 0.05). The differences in the mean arterial pressure and heart rate during surgery in Group II were significantly greater than those in Groups I and III (P < 0.05). The intraoperative VAS scores in Group II were higher than those in Groups I and III (P < 0.05) and at 8 and 12 h postoperatively. There were no significant differences in VCSS among the groups (P ≥ 0.05).
UNASSIGNED: The use of a tumescent anesthetic solution composed of lidocaine and ropivacaine significantly improved patient comfort during the perioperative period without affecting surgical outcomes. This formulation can be considered safe and reliable for preparing tumescent anesthesia solutions.

暂无摘要。

OBJECTIVE: To evaluate the efficacy and safety of ultrasound-guided femoral nerve block (FNB) in treating great saphenous vein (GSV) insufficiency by endovenous radiofrequency ablation (EVRA) combined with punctate stripping (PS).
METHODS: This was a single-center, retrospective cohort study. A total of 135 patients were divided into Group A (59 patients) and Group B (76 patients). All patients received tumescent anesthesia during the operation, and group A received an additional ultrasound-guided FNB before the procedure. Intraoperative and postoperative pain score, the volume of tumescent anesthesia solution (TAS), and other indicators were compared in two groups.
RESULTS: Group A had a significantly lower intraoperative pain visual analog scale than group B (2.7 ± 1.2 vs 5.2 ± 1.5, P < 0.001). The volume of TAS in group A was significantly lower than that in group B (198 ± 26.6 ml vs 338 ± 34.7 ml, P < 0.001). Postoperative muscle strength of group A was significantly decreased compared with group B (54.2% vs 3.90%, P < 0.001); no patient had severe limitation of active movements in both groups, and all motor blocks recovered within 24 h. The incidence of skin ecchymosis in group A was lower than that in group B (18.6% vs 46.1%, P = 0.001). The operation duration of the two groups had no statistically significant difference.
CONCLUSIONS: Ultrasound-guided FNB in treating GSV insufficiency by EVRA combined with PS significantly relieved intraoperative pain and reduced the dosage of TAS and the incidence of skin ecchymosis without increasing the complications of anesthesia or any other surgical complications.

Sentinel node biopsy is performed to stage clinically and radiographically occult regional disease in cases of malignancy, including cutaneous cancer such as melanoma. The use of tumescent anesthesia with sentinel node biopsy for cutaneous malignancies has not been well studied. Therefore, we aimed to compare the rate of successful sentinel node identification and estimated blood loss between patients who underwent sentinel node biopsy with and without the use of tumescent anesthesia.
A retrospective review was conducted of a prospectively maintained single-institution database of all patients who underwent reconstruction after the extirpation of a cutaneous malignancy over an 18-month period. Patient demographics, tumor histology, and characteristics, indication for and success of sentinel node biopsy, use of tumescent anesthesia, and total estimated blood loss were examined.
Sentinel node biopsy was performed in 15 of 39 patients (38.5%) receiving tumescent anesthesia compared with 6 of 26 patients (23.1%) not receiving it (p = 0.19). Sentinel node biopsy had a success rate of 100% in the tumescent and nontumescent anesthesia groups. The mean estimated blood loss in the tumescent anesthesia group was 36.7 mL versus 59.6 mL in the nontumescent anesthesia group (p < 0.001). Complication rates were comparable between the tumescent anesthesia (12.8%) and nontumescent anesthesia (19.2%) groups (p = 0.48).
The use of tumescent anesthesia in cutaneous malignancy extirpation and immediate reconstruction was not associated with a decreased sentinel node identification rate or change in complication rates. However, tumescent anesthesia was associated with a decrease in the estimated blood loss.

In recent years, there has been an increase in demand for gluteal augmentation and reshaping surgeries with intramuscular implants which are becoming increasingly popular. Until now, this surgery was mainly performed under general anesthesia, but recently locoregional anesthesia techniques, such as tumescent local anesthesia, are being applied more and more. Today, the use of ultrasound for locoregional anesthesia and analgesia allows us to perform techniques that are increasingly precise and burdened with lower risks. In this report, we present a novel two-step ultrasound-guided technique combining a botox injection in the gluteus maximus four weeks before surgery and tumescent anesthesia with a cluneal nerve block. Furthermore, the combination of anesthetic and analgesic techniques can guarantee a better result both in terms of surgical execution of the intervention and in reducing pain and improving patient comfort in the postoperative period.

This is a retrospective analysis of all lipedema patients treated by tumescent liposuction at our department in the years 2007-2021: We performed 519 liposuctions in 178 patients with a mean age of 45 ± 15.5 years. By the stage of lipedema the mean age increased significantly, what underlines the concept of lipedema as a chronic progressive disorder. Three-thirds of patients reported at least one comorbidity. The most common were arterial hypertension (32.58%), obesity (24.16%), and hypothyroidism (20.79%). We removed a mean lipoaspirate volume of 4905 ± 2800 mL. A major target for treatment is pain reduction. All patients reported at least a 50% pain reduction after liposuction, while 96 achieved a pain reduction ≥ 90%. The pre-operative pain intensity (p = 0.000) and the lipedema stage (p = 0.032) exerted a significant impact on absolute pain reduction. There was no association of pain reduction to volume loss. The post-operative rate of adverse events was 2.89%. Liposuction in tumescent anesthesia is an effective and safe method to reduce both pain and volume in patients with lipedema.
UNASSIGNED: Wir berichten in einer retrospektiven Auswertung aller Fälle der Jahre 2007–2021 über die Resultate von 519 Liposuktionen in Tumeszenzanästhesie bei 178 Patientinnen mit einem Lipödem. Das Durchschnittsalter betrug 45 ± 15,5 Jahre. Mit dem Stadium des Lipödems nahm das durchschnittliche signifikant zu, was die Einordnung des Lipödems als chronisch-progrediente Erkrankung unterstreicht. Dreiviertel der Patientinnen hatten mindestens eine Begleiterkrankung. Die häufigsten Komorbiditäten waren die arterielle Hypertonie (32,58 %), die Adipositas (24,16 %) und die Hypothyreose (20,79 %). Im Mittel wurden 4905 ± 2800 mL Lipoaspirat entfernt. Hauptziel der Therapie ist die Schmerzminderung. Alle Patientinnen gaben eine mindestens 50 %ige Schmerzreduktion nach Liposuktion an, 96 Frauen erzielten eine Schmerzreduktion von ≥ 90 %. Der präoperative Schmerzwert (p = 0,000) und das Lipödemstadium (p = 0,032) hatten einen signifikanten Einfluss auf die absolute Schmerzreduktion. Es bestand kein Zusammenhang von Schmerzlinderung und Volumenreduktion der behandelten Extremitäten. Die postoperative Nebenwirkungsrate lag bei 2,89 %. Die Liposuktion in Tumeszenzanästhesie ist eine wirksame und sichere Methode zur Schmerzminderung und Volumenreduktion bei Patientinnen mit einem Lipödem.

Axillary bromhidrosis, which involves the apocrine sweat glands, severely affects adolescents. The present study aimed to evaluate the effect of tumescent anesthesia technique combined with superficial fascia rotational atherectomy treatment for axillary bromhidrosis. The present retrospective study included a total of 60 patients with axillary bromhidrosis. These patients were divided into experimental and control groups. Patients in the control group were treated using the tumescent anesthesia technique combined with conventional surgery, while patients in the experimental group were treated using the anesthesia technique combined with superficial fascia rotational atherectomy. The intraoperative blood loss, operation time, histopathological examination and dermatology life quality index (DLQI) score were used to assess the treatment effect. The intraoperative blood loss and operation time were significantly lower in the experimental group compared with the control group. The histopathological results revealed that the sweat gland tissues in experiment group significantly decreased compared with that in control group. Furthermore, there was a significant improvement in axillary odor degree for postoperative patients, and the DLQI scores in experiment group were significantly lower compared with those in control group. The tumescent anesthesia technique combined with superficial fascia rotational atherectomy is a promising approach to treating patients with axillary bromhidrosis.

UNASSIGNED: To analyze and explore the clinical efficacy of ultrasound guided femoral nerve block combined with modified swelling anesthetic solution in high ligation and stripping of the great saphenous vein.
UNASSIGNED: 90 patients with varicose great saphenous vein of lower limbs undergoing high ligation and stripping of great saphenous vein were randomly divided into group A (femoral nerve block combined with modified swelling anesthesia), group B (simple swelling anesthesia) and group C (epidural anesthesia), with 30 patients in each group. The serum CRP level, operation duration, intraoperative blood loss, postoperative hospitalization time, total hospitalization cost, postoperative VAS score, preoperative and postoperative VCSS score, intraoperative mean arterial pressure and heart rate, postoperative related complications, and patients, satisfaction with diagnosis and treatment were compared among the three groups.
UNASSIGNED: There was no significant difference in operation duration, intraoperative blood loss, postoperative complications, and preoperative and postoperative VCSS scores among the three groups (P > 0.05). The postoperative hospitalization time, postoperative VAS score and total hospitalization cost of patients in group A and B were lower than those in group C, and the postoperative hospitalization time and postoperative VAS score in group A were more significant (P < 0.05). Compared with group B, the fluctuation range of intraoperative mean arterial pressure and heart rate, and postoperative serum CRP level in group A and C were lower, especially in group A (P < 0.05). The three groups of patients were followed up regularly after surgery. The results showed that the number of postoperative complications in group A was lower than that in the other two groups (P < 0.05), and the postoperative complications of the three groups were effectively relieved after symptomatic treatment (dressing change, anti-infection, taking drugs to improve circulation, etc.). The satisfaction of patients in group A was significantly higher than that in groups B and C (P < 0.05).
UNASSIGNED: Ultrasound guided femoral nerve block combined with modified swelling anesthetic solution applied in high ligation and stripping of the great saphenous vein can significantly improve postoperative inflammatory stress reaction of patients, effectively ensure the safety and reliability of surgical progress, help to improve analgesia effect and accelerate physical rehabilitation, and has short hospitalization time, low medical cost, and high satisfaction of patients\' diagnosis and treatment, which is worthy of widespread clinical promotion and reference.

The wide-awake local anesthesia no tourniquet (WALANT) technique is currently being used by several hand surgeons. This technique enables surgeries to be performed with the patient fully awake and without a tourniquet, thus allowing the intraoperative assessment of function. The purpose of this article was to describe our WALANT techniques for metacarpal, scaphoid, distal radius, radial head, and olecranon fracture fixation with its pearls and pitfalls. The authors demonstrate their infiltration technique, detailing how to perform it using lidocaine with 1:100,000 epinephrine and 8.4% sodium bicarbonate. The authors describe where to start the tumescent anesthesia in each type of fracture described. To achieve a painless surgery under WALANT, it is crucial to administer the subcutaneous anesthetic injection around the incision site and at the periosteum to surround the entire fractured bone circumferentially. Before making the incision, the fracture site must be manipulated and the patient should not experience any pain. As a routine in every WALANT procedure, we wait at least 25 minutes to start the surgery, as this is the optimal time interval to achieve maximal vasoconstriction within the limits of tumescent anesthesia. In all operated cases, it was possible to conduct intraoperative assessment of the range of motion of the elbow, wrist, hand, and fingers, in addition to evaluating the fixation stability through active motion and ensuring earlier rehabilitation.

BACKGROUND: Local tumescent anesthesia relieves postoperative pain.
OBJECTIVE: The objective of the study was to compare the effect of injecting a tumescent solution with/without ropivacaine on postoperative pain.
METHODS: A randomized, double-blind control study was conducted in 314 patients who underwent first follicular unit excision after obtaining informed consent and ethics committee approval. The patients were randomly divided into three groups: intra-groups (group 1, injected with tumescent solution with ropivacaine; group 2, without ropivacaine) and inter-group (group 3, right-head/left-head side with/without ropivacaine). Postoperative pain was recorded using the 5-point Wong-Baker Faces Pain Scale. No preoperative analgesic was administered to any patient. The survival rate of hair follicles was measured using dermoscopy during follow-up. Data were statistically analyzed.
RESULTS: Of the 314 patients included in the study, 166 were men and 148 were women with a mean age of 32.15 ± 4.58 (range, 25-45) years. Postoperative pain with ropivacaine was significantly more relieved compared with that without ropivacaine in both groups (p < 0.05). There was no significant difference between sex and survival rate of hair follicles in the intra- or inter-group.
CONCLUSIONS: A tumescent solution with ropivacaine has proven to relieve postoperative pain and is a safe and valuable form of local anesthesia in follicular unit excision.