Comment to: Evaluation of pain in varicose vein surgery under tumescent local anesthesia using sodium bicarbonate as excipient without any intravenous sedation, by Creton D, Re’a B, Pittaluga P, Chastanet S, Allaert FA. Phlebology 2011:1-6.

The aim of this survey was to study the feasibility of varicose vein surgery under tumescent local anesthesia (TLA). A total of 215 patients at two private surgical centers in France were included. All the operations were performed under TLA without any intravenous sedation. The tumescent liquid was obtained by diluting lidocaine 1% (20 mL containing 200 mg lidocaine). A solution of 14 mL of 1% lidocaine (with 1:100,000 epinephrine) was diluted in a bottle with 500 mL of 1.4% sodium bicarbonate (lidocaine dilution at approx. 0.028%). Injections were performed with 25 gauge needles, with syringes or an electric pump. Patients had to arrive in the morning after eating breakfast as usual. Surgery was performed in an operating theater without any particular monitoring. The patients’ faces were not covered with sterile operative fields to allow visual and oral communication. Operations included either phlebectomies or stripping or thermoablation of truncular segments (Table 1)...