Evaluation of lidocaine as an analgesic when added to hypertonic saline for sclerotherapy

Purpose: The efficacy of sclerosing agents for the treatment of telangiecta sias and reticular veins is well established. The injection of these agents is often associated with pain, and it is not uncommon for sclerotherapists to include lidocaine with the sclerosants in an attempt to reduce the pain associated with treatment. However, there are concerns that this may reduc e the overall efficacy of the treatment because of dilution of the sclerosa nt. Patient comfort and overall outcome associated with treatment using HS with lidocaine (LIDO) versus that using HS alone was compared. Methods: Forty-two patients were prospectively entered into the study and r andomized blindly to sclerotherapy with 23.4% HS or 19% LIDO. Study subject s and treating physicians were blinded to the injection solution used. Inje ction sites were chosen for veins ranging in size from 0.1 to 3 mm. Photogr aphs of the area to be treated were taken, and the patients rated their pai n. They were then observed at regular intervals for four months, and clinic al data was collected. Thirty-five subjects completed the full follow-up pe riod, and photographs of the injected area were taken again. Three investig ators blinded to the treatment assignment then evaluated the photographs an d scored the treatment efficacy according to a standardized system. Results: In the HS group, 61.9% (13 of 21) patients rated their pain as non e or mild, whereas 90.5% (19 of 21) of patients in the LIDO group had no or mild discomfort. This difference is significant, with a P value of .034. T here was no difference in the overall efficacy of treatment between the two groups. The groups had similar rates of vein thrombosis and skin necrosis. Conclusion: Although lidocaine is often used with sclerosing agents, there are no previous reports in the literature to evaluate its effectiveness in reducing the pain experienced by the patient. In this study, patients recei ving LIDO experienced significantly less discomfort at the time of injectio n than patients who received HS alone. There were no differences in the eff ectiveness of treatment or in the incidence of complications between the tw o groups.