Skin necrosis after hook phlebectomy of varicose veins

Phlebologie ◽  
2007 ◽  
Vol 36 (01) ◽  
pp. 21-24
Author(s):  
P. P. Krobisch
Keyword(s):  
Sodium Bicarbonate ◽  
Sodium Carbonate ◽  
Local Anaesthetic ◽  
Local Anaesthesia ◽  
Skin Necrosis ◽  
Varicose Veins

Summary Background: Hook phlebectomy is usually performed under local anaesthesia. Several modifications of local anaesthesia have been proposed, including the reduction of the concentration of the local anaesthetic, the increase of the volume, the addition of norepinephrine and sodium bicarbonate. Patients, method: Three episodes are reported of painless skin necrosis after local anaesthesia using mepivacain (0.5 or 1%) with added sodium bicarbonate (8.4%, 1 : 10). Results: Degradation of the solution used for local anaesthesia was the cause of the necroses. The stopcock securing the bottle containing the stock solution of sodium bicarbonate allowed CO2to evaporate leaving sodium carbonate in the vial with a pH of 11. This solution was diluted 1 in 10 with mepivacain. The injections were painless and the necroses only were detected after three days when the bandages were removed. Discussion: Risks are inherent to even small changes of remedies. Conclusion: Home-made solutions must meet pharmaceutical standards in order to guarantee safety.

scholarly journals Evaluation of liquid or foam sclerotherapy in small varicose veins (ceap c1) with venous clinical severity score

2018 ◽  
Vol 64 (12) ◽  
pp. 1117-1121 ◽  
Author(s):  
Mehmet Ali Kaygin ◽  
Umit Halici
Keyword(s):  
Severity Score ◽  
Skin Necrosis ◽  
Varicose Veins ◽  
Clinical Severity ◽  
Foam Sclerotherapy ◽  
Clinical Severity Score ◽  
Severity Scores ◽  
Study Results ◽  
Venous Clinical Severity Score ◽  
The Mean

SUMMARY OBJECTIVE: We aimed to evaluate the efficacy of liquid or foam sclerotherapy of varicose veins using venous clinical severity scores and possible complications. METHODS: A total of 318 patients (268 females, 50 males) who were treated with liquid or foam sclerotherapy between January 2012 and December 2012 were included in this study. RESULTS: Skin necrosis was observed in only 6 patients (1. 8%), thrombophlebitis in 10 patients (3. 1%), and hyperpigmentation in 18 patients (5. 6%) in this study group. The mean venous clinical severity score was calculated as: pain score, 1. 23 ± 0.88; varicose vein score,1.85 ± 0. 8; edema score, 0.64 ± 0.77). Pain and edema decreased at the control examination, 1 month after completion of sclerotherapy sessions. Varicose veins completely disappeared after sclerotherapy. While the decrease in edema in the foam sclerotherapy group was significantly less (P<0.001), the decline in pain showed an increasing trend (P=0.069). While skin necrosis did not develop after foam sclerotherapy, rates of pigmentation and local thrombophlebitis were similar (P>0.05). CONCLUSION: In conclusion, we observed that both sclerotherapy methods are effective with a low rate of complications, alleviating the complaints of patients with small varicose veins, and providing considerable improvement in venous clinical severity scores.

scholarly journals Defining features in the kinetics of sodium carbonate-bicarbonate solution carbonization and the quality of the resulting sodium bicarbonate crystals

2021 ◽  
Vol 4 (10(112)) ◽  
pp. 38-44
Author(s):  
Mykola Porokhnia ◽  
Musii Tseitlin ◽  
Svitlana Bukhkalo ◽  
Vladimir Panasenko ◽  
Tetiana Novozhylova
Keyword(s):  
Carbon Dioxide ◽  
Sodium Bicarbonate ◽  
Sodium Carbonate ◽  
Diffusion Resistance ◽  
Crystal Formation ◽  
Gas Velocity ◽  
Laboratory Equipment ◽  
Gas Consumption ◽  
Kinetics Of

This paper reports a study into the influence of temperature and gas consumption on the carbonization kinetics (saturation with carbon dioxide) of sodium carbonate-bicarbonate solution. The study also examined the quality and speed of crystal formation in this process. This research is predetermined by the environmental problems faced by modern enterprises that produce purified sodium bicarbonate – an insufficient degree of carbonization and, as a result, excessive air pollution with carbon dioxide, which did not participate in the reaction during the process. This study addresses these particular issues. As a result of using specialized laboratory equipment, it was found that an increase in the absorbent temperature from 79 to 85 °C leads to a decrease in the maximum degree of carbonization of the solution from 64 to 59 %. In contrast, the quality of the resulting sodium bicarbonate crystals improves but only in the range from 79 to 82 °C. With a further increase in temperature, the quality stabilizes. It is shown that the carbonization rate increases with increasing specific consumption of the absorbent (carbon dioxide) and is characterized by a negative correlation with the value of oversaturation of the absorbent in terms of NaНCO3. The quality of sodium bicarbonate crystals decreases with increasing gas velocity. Thus, it was reasonable to assume that the established dependence of the kinetics of carbonization of Na2CO3 and NaНCO3 solution on the gas velocity in the apparatus is explained by the inhibition of СО2 absorption, which is caused by the diffusion resistance of sodium bicarbonate crystallization. To improve the quality of crystals and the productivity of carbonization by reducing the supersaturation in terms of NaНCO3, it is recommended to introduce a seed crystal in the zone of binding of crystals in the carbonization columns.

The treatment of varicose veins: an investigation of patient preferences and expectations

2010 ◽  
Vol 25 (2) ◽  
pp. 54-65 ◽  
Author(s):  
A C Shepherd ◽  
M S Gohel ◽  
C S Lim ◽  
M Hamish ◽  
A H Davies
Keyword(s):  
Local Anaesthetic ◽  
Varicose Veins ◽  
Treatment Decision ◽  
Treatment Preference ◽  
Multiple Choice Questions ◽  
Foam Sclerotherapy ◽  
Vascular Surgeon ◽  
Anonymous Questionnaire ◽  
Treatment Type ◽  
Endovenous Treatment

Objectives A number of modalities are now available for the treatment of varicose veins. The aim of the study was to investigate the factors considered important by patients when contemplating treatment of their varicose veins. Methods Consecutive new patients referred to a vascular surgery service were invited to complete a short anonymous questionnaire prior to their consultation. The questionnaire consisted of 13 multiple choice questions relating to symptoms, potential varicose vein treatments and patient knowledge of existing therapies. Results Of 111 patients, there were 83 complete responses (75%). Symptoms of pain or aching were reported as moderate or severe by 77/103 (75%) of patients and significantly limited the activities of 47/101 (47%). Although the majority (89/103 [86%]) of patients were aware of surgery, only 52/103 (51%) knew of the existence of endothermal ablation (either laser or radiofrequency) and only 23/103 (22%) were aware of foam sclerotherapy. Some 58/92 (63%) were in favour of local anaesthetic treatment. Most patients (74/103, 72%) felt inadequately informed to express a preference regarding treatment type prior to their consultation, although 24/103 (23%) expressed a preference for endovenous treatment. Interestingly, 74/92 (80%) stated that the opinion of their vascular surgeon would be likely to or definitely influence their treatment decision and the majority of patients stated that what they had read in magazines (54/80, 64%) or on the Internet (51/85, 60%) would have no influence on their decision regarding treatment, respectively. Conclusion Only a minority of patients referred with varicose veins were aware of endovenous treatments or felt adequately informed to express a treatment preference prior to consultation. Over half of patients expressed a preference for local anaesthetic therapy and a preference for a single visit treatment, although most would be strongly influenced by the opinion of their vascular surgeon and not influenced by media advertising.

Analgesia and anaesthesia

2020 ◽  
pp. 281-327
Author(s):  
Jonathan P. Wyatt ◽  
Robert G. Taylor ◽  
Kerstin de Wit ◽  
Emily J. Hotton ◽  
Robin J. Illingworth ◽  
...  
Keyword(s):  
Emergency Department ◽  
Nerve Block ◽  
Local Anaesthetic ◽  
Local Anaesthesia ◽  
Femoral Nerve Block ◽  
Rapid Sequence Induction ◽  
Femoral Nerve ◽  
General Anaesthetic ◽  
Intravenous Sedation ◽  
Nerve Blocks

This chapter in the Oxford Handbook of Emergency Medicine investigates analgesia and anaesthesia in the emergency department (ED). It looks at options for relieving pain, such as the analgesics aspirin, paracetamol, non-steroidal anti-inflammatory drugs (NSAIDs), morphine and other opioids, Entonox®, and ketamine, and explores analgesia for trauma and other specific situations. It discusses local anaesthesia (LA) and local anaesthetic toxicity, including use of adrenaline (epinephrine) and general principles of local anaesthesia. It explores blocks such as Bier’s block, local anaesthetic nerve blocks, intercostal nerve block, digital nerve block, median and ulnar nerve blocks, radial nerve block at the wrist, dental anaesthesia, nerve blocks of the forehead and ear, fascia iliaca compartment block, femoral nerve block, and nerve blocks at the ankle. It examines sedation, including drugs for intravenous sedation and sedation in children, and discusses general anaesthesia in the emergency department, emergency anaesthesia and rapid sequence induction, difficult intubation, and general anaesthetic drugs.

Pain and outcomes of carpal tunnel release under local anaesthetic with or without a tourniquet: a randomized controlled trial

2018 ◽  
Vol 43 (8) ◽  
pp. 808-812 ◽  
Author(s):  
Hafiz J. Iqbal ◽  
Ashtin Doorgakant ◽  
Nader N. T. Rehmatullah ◽  
Ashok L. Ramavath ◽  
Prasad Pidikiti ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Carpal Tunnel ◽  
Local Anaesthetic ◽  
Local Anaesthesia ◽  
Controlled Trial ◽  
Carpal Tunnel Release ◽  
Similar Degree ◽  
Level Of Evidence ◽  
Randomized Controlled ◽  
Anaesthetic Mixture

We conducted a prospective randomized controlled trial to investigate carpal tunnel decompression under local anaesthesia. Carpal tunnel decompression was performed in 37 wrists using local anaesthesia and an arm tourniquet and 36 without tourniquet but with a local anaesthetic mixture containing adrenaline. Patients who underwent carpal tunnel decompression using a tourniquet experienced a significantly greater degree of pain when compared with those who did not have a tourniquet. Pain and hand function improved to a similar degree in both groups. We conclude that carpal tunnel decompression performed with a tourniquet causes patients unnecessary pain with no additional benefit as compared with the wide-awake carpal tunnel decompression without use of a tourniquet. Level of evidence: I

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