Tumescent anesthesia in ambulatory phlebectomy: Addition of epinephrine

BACKGROUND. The advantages of using tumescent anesthesia for ambulatory phl ebectomy have recently been described. Previously, tumescent solutions have avoided epinephrine for concerns of toxicity given the large volume of ane sthetic sometimes used. OBJECTIVE. TO evaluate the efficacy and safety of using epinephrine in the tumescent anesthesia solution during ambulatory phlebectomy. METHODS. Over the course of 1 year, epinephrine in the concentration of 1:1 00,000 was added to the tumescent solution of patients undergoing ambulator y phlebectomy. A retrospective review of 94 sequential patients was perform ed to determine the rate of complications associated with the procedure. RESULTS. The complication rate was considerably improved using tumescent li docaine with epinephrine compared to a previously performed study of tumesc ent lidocaine without epinephrine. The rate of hematoma was decreased to ni l while the rate of hyperpigmentation decreased from 3.6% to 0%. Overall, t he rate of complications was improved when epinephrine was added to the tum escent lidocaine solution. Blood pressure measured every 5 minutes and hear t rate measured continuously did not significantly change before, during or after infiltration of the anesthetic solution. CONCLUSIONS. Epinephrine in appropriate concentrations is clearly safe when used in the tumescent anesthetic solution during ambulatory phlebectomy an d should be used to reduce the incidence of hematoma and hyperpigmentation.