title: Prospective study of a single treatment strategy for local tumescent anesthesia in Muller phlebectomy.
abstract: BACKGROUND
  Ambulatory Muller phlebectomy for varicose veins can be performed under local anesthesia. However, subcutaneous injection of local tumescent anesthetics may cause discomfort because of acidity of the solution. Addition of sodium bicarbonate lowers the acidity of anesthetic solutions, which might cause less pain. The objective of this study was to study whether alkalinization of the local anesthetic solution with sodium bicarbonate 1.4% decreases perioperative pain during Muller phlebectomies.
  
  
  METHODS
  It is a double-blind single-center randomized controlled trial. In all, 101 patients scheduled for ambulatory Muller phlebectomy were randomized to receive either local anesthesia with alkalinized solution (lidocaine 1% and epinephrine in sodium bicarbonate 1.4%) or standard solution (lidocaine 1% and epinephrine in saline 0.9%). Primary outcome was pain during injection of local anesthetics with the use of the Visual Analogue Scale (VAS). Secondary outcomes were peroperative and postoperative pain, use of analgesics, patient satisfaction, return to function, and complications.
  
  
  RESULTS
  Patients receiving subcutaneous injection of local anesthetics diluted in sodium bicarbonate 1.4% experienced significantly less pain during injection compared with patients treated with standard anesthetic solution (VAS, 1.75 ± 1.8 vs. 3.55 ± 2.2, P < 0.00). Peroperative and postoperative pain, complication rates, use of analgesics, patient satisfaction, return to function, and complications did not differ between the 2 groups (P > 0.10).
  
  
  CONCLUSIONS
  Alkalinization of local anesthetic solution with sodium bicarbonate 1.4% significantly improves patient comfort during injection of local tumescent anesthesia.
authors.affiliation: Department of Surgery, Atrium Medical Centre, Heerlen, The Netherlands.
authors.forename: Attila G
authors.initials: AG
authors.lastname: Krasznai
authors.affiliation: Department of Surgery, Atrium Medical Centre, Heerlen, The Netherlands. Electronic address: timsigterman@gmail.com.
authors.forename: Tim A
authors.initials: TA
authors.lastname: Sigterman
authors.affiliation: Department of Surgery, Atrium Medical Centre, Heerlen, The Netherlands.
authors.forename: Charelle E
authors.initials: CE
authors.lastname: Willems
authors.affiliation: Department of Pharmacy, Atrium Medical Centre, Heerlen, The Netherlands.
authors.forename: Peter
authors.initials: P
authors.lastname: Dekkers
authors.affiliation: Department of Surgery, Atrium Medical Centre, Heerlen, The Netherlands.
authors.forename: Maarten G J
authors.initials: MG
authors.lastname: Snoeijs
authors.affiliation: Department of Surgery, MUMC, Maastricht, The Netherlands; Department of Surgery, Uniklinik Aachen, Aachen, Germany.
authors.forename: Cees H A
authors.initials: CH
authors.lastname: Wittens
authors.affiliation: Department of Surgery, Atrium Medical Centre, Heerlen, The Netherlands.
authors.forename: Cees-Jan
authors.initials: CJ
authors.lastname: Sikkink
authors.affiliation: Department of Surgery, Atrium Medical Centre, Heerlen, The Netherlands.
authors.forename: Lee H
authors.initials: LH
authors.lastname: Bouwman
mesh_terms: D000328:Adult; D000368:Aged; D000700:Analgesics / Q000627:therapeutic use; D000772:Anesthesia, Local / Q000009:adverse effects; D000779:Anesthetics, Local / Q000008:administration & dosage* / Q000009:adverse effects / Q000737:chemistry; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007279:Injections, Subcutaneous; D053208:Kaplan-Meier Estimate; D008012:Lidocaine / Q000008:administration & dosage* / Q000009:adverse effects / Q000737:chemistry; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D010146:Pain / Q000139:chemically induced / Q000175:diagnosis / Q000517:prevention & control*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000209:etiology / Q000517:prevention & control; D017060:Patient Satisfaction; D011446:Prospective Studies; D020127:Recovery of Function; D017693:Sodium Bicarbonate / Q000008:administration & dosage / Q000737:chemistry; D013997:Time Factors; D016896:Treatment Outcome; D014648:Varicose Veins / Q000175:diagnosis / Q000601:surgery*; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000379:methods*
chemical_list: D000700:Analgesics; D000779:Anesthetics, Local; D017693:Sodium Bicarbonate; D008012:Lidocaine