Long saphenous tunnel infiltration with levobupivicaine reduces rescue analgesia requirements following varicose vein surgery: randomized, double-blind, placebo-controlled trial [ISRCTN58431114]

Abstract

Objectives: To determine whether local anaesthetic infiltration of the long saphenous tunnel in patients undergoing unilateral, primary long saphenous stripping and multiple avulsions reduces early postoperative pain and requirement for opiate analgesia. Methods: Patients were randomized to receive either levobupivicaine or an equivalent volume of normal saline infiltrated around the groin incision and along the long saphenous tunnel. Analgesia and linear analogue pain scores at 1, 6 and 24 h postoperatively were recorded. Results: Fourteen patients received local anaesthetic and 13 patients received saline placebo. The anaesthetic group experienced a 22% reduction in pain scores 1 h postoperatively and a 48% reduction at 6 h although this failed to achieve statistical significance. However, the anaesthetic group were less likely to require morphine in recovery (2/14 [14%] versus 8/13 [62%]; P = 0.01). The high morphine requirements in the control group may have reduced the amount of pain those patients recorded on their pain scores and prevented statistical significance from being achieved. Conclusion: In varicose vein surgery, local anaesthetic infiltration to the groin wound and along the full length of the stripper track is associated with reduced postoperative pain and requirements for opiate analgesia.