Impact of Dexamethasone-Enriched Tumescent Anesthesia for Radiofrequency Ablation of GSV insufficiency: A Double-Blind Randomized Clinical Trial.

Abstract

To evaluate whether dexamethasone enriched tumescent local anesthesia (TLA) fluid reduces post-operative pain and improves recovery outcomes following radiofrequency ablation(RFA) for great saphenous vein (GSV) insufficiency. Post-operative pain and local complications of RFA for GSV insufficiency remain significant concerns. Identifying strategies to improve patient outcomes is critical for optimizing care. Double-blind, randomized clinical trial was conducted. Adult patients with GSV insufficiency classified as CEAP C2-C5 were included. The treatment group received dexamethasone enriched TLA fluid, while the control group received traditional TLA fluid. Standard RFA procedures were performed in both groups. The primary outcome was post-operative pain measured by the Visual Analogue Scale (VAS). Secondary outcomes included quality of life (EQ-VAS, EQ-5D), Venous Clinical Severity Score (VCSS), local complications, and GSV occlusion rates. A total of 136 patients were randomized (67 treatment group, 69 control group). Median pain scores on day 1 and 3 were significantly lower in the treatment group compared to the control group [1 (IQR: 0-2) vs. 2 (IQR: 1-3), P=0.010; 0 (IQR: 0-1) vs. 1 (IQR: 0-2), P=0.007]. Ecchymosis incidence was reduced in the treatment group (58.7% vs. 75.4%; P=0.042). No significant differences were observed in VCSS scores, EQ-5D scores, thrombosis incidence, or GSV occlusion rates. Dexamethasone enriched TLA fluid during RFA reduces early postoperative pain and ecchymosis without increasing complications. This approach offers a cost-effective enhancement to RFA protocols for non-diabetic patients.