Objectives: Clinical experience suggested that preoperative infiltration of proposed avulsion sites with bupivacaine and adrenaline reduced bleeding associated with varicose vein surgery. This hypothesis was subjected to a randomized controlled trial. Methods: Twenty patients undergoing bilateral long saphenous vein (LSV) stripping and avulsions were randomized to have one leg infiltrated with 0.25% bupivacaine and the other with 0.25% bupivacaine with adrenaline (1 in 200,000). Following induction of general anaesthesia, 10 mL of local anaesthetic was infiltrated into the groin and 20-30 mL over the marked varicosities down the leg. Bilateral PIN stripping and hook avulsions were performed. Operative blood loss was recorded for each leg and the area of strip-site and avulsion-site bruising was determined five days postoperatively. Results: There was no difference in the numbers of avulsions between the legs receiving adrenaline (median 12, range 4-23) and controls (median 13, range 4-25), but adrenaline significantly reduced the operative blood loss (median 41 mL, range 17-122) compared with control legs (median 79 mL, range 28-210; P < 0.001, Wilcoxon). There was also a significant reduction in postoperative avulsion-site bruising (median 45 cm(2), range 13-101 compared with median 70 cm(2), range 34-221; P<0.001.). There was a smaller reduction in strip-site bruising (median 50 cm(2), range 14-128 compared with median 62 cm(2), range 21-141; P<0.001). Conclusions: Preoperative infiltration with bupivacaine and adrenaline is safe and reduces bleeding and bruising associated with varicose vein surgery.
