title: Technique, Efficiency and Safety of Different Nerve Blocks for Analgesia in Laser Ablation and Sclerotherapy for Lower Limb Superficial Venous Insufficiency - A Multicentre Experience.
abstract: BACKGROUND
  Laser ablation and sclerotherapy, as minimally invasive alternatives to surgery for varicose veins, have good efficacy, safety and cosmetic result. Some form of anaesthesia is generally used for pain control.
  
  
  OBJECTIVE
  To describe the technique and evaluate the efficacy and safety of femoral, saphenous and sciatic nerve blocks in isolation or in combination for analgesia during laser ablation and sclerotherapy for lower limb varicose veins.
  
  
  METHODS
  In this prospective observational study, over a period of 33 months, in 856 limbs of 681 patients with varicose veins, ultrasound guided femoral, saphenous and sciatic nerve blocks for analgesia were performed in 769, 808 and 52 instances respectively; following which, endovenous laser ablation, sclerotherapy or combination of both were carried out using standard practice. After completion of the procedure, Visual Analogue Pain Scale (VAS) was used for pain assessment, and muscle weakness was assessed clinically.
  
  
  RESULTS
  Nerve blocks could be successfully performed in all patients. Observed pain scores were 0 or 1 in 591 (69%), 2 or 3 in 214 (25%) and 4 in 51 (9%) legs with no score more than 4. Higher grades of pain were noted in femoral blocks during early stages of our learning curve. Mild to moderate muscle weakness was observed in 163 (2%) and 7 (13%) patients who underwent femoral and sciatic block respectively, which persisted for an average of two and a half hours and none beyond four and a half hours; saphenous nerve being a pure sensory nerve, did not cause motor weakness.
  
  
  CONCLUSIONS
  For analgesia during laser ablation and/or sclerotherapy of varicose veins, ultrasound guided nerve blocks can be easily and quickly performed. They provide excellent pain relief and comfort to the patient and to the operator; and they do not cause any additional complication.
authors.affiliation: Consultant Interventional Radiologist, Department of Radiology, Rajagiri Hospital , Kochi, Kerala, India .
authors.forename: Krishna Prasad Premnath
authors.initials: KP
authors.lastname: Bellam
authors.affiliation: Head of Radiology Services, Department of Radiology, Rajagiri Hospital , Kochi, Kerala, India .
authors.forename: Binu
authors.initials: B
authors.lastname: Joy
authors.affiliation: Consultant Interventional Radiologist, Department of Radiology, Maxcure Hospitals , Hyderabad, Telangana, India .
authors.forename: Abhilash
authors.initials: A
authors.lastname: Sandhyala
authors.affiliation: Consultant Interventional Radiologist, Department of Radiology, Dr. D. Y. Patil Medical College Hospital and Research Center , Pune, Maharashtra, India .
authors.forename: Kiran
authors.initials: K
authors.lastname: Naiknaware
authors.affiliation: Senior Specialist, Department of Imaging and Interventional Radiology, Aster Medcity Hospital , Kochi, Kerala, India .
authors.forename: Brijesh
authors.initials: B
authors.lastname: Ray
authors.affiliation: Consultant Interventional and Cardiac Radiologist, Radiology, Ramesh Hospitals , Guntur, Andhra Pradesh, India .
authors.lastname: Vijayakumar
keywords: Femoral nerve; Saphenous nerve; Sciatic nerve; Varicose veins