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ESRA19-0560 EVLA (endovenous laser ablation) using nalbuphine/propofol based conscious sedation with tumescent anaesthesia in daycare facility: pain-free for patients and stress-free for surgeons – a south-asian perspective
  1. P Khandelwal1,
  2. S Joshi2,
  3. R Basapure2,
  4. A Joshi3 and
  5. K Basapure1
  1. 1The Vein Center, Anaesthesiology, Mumbai, India
  2. 2The Vein Center, Interventional Radiology, Mumbai, India
  3. 3The Vein Center, Obstetrics and Gynaecology, Mumbai, India


Background and aims The majority of patients presenting with varicose veins in South-Asian communities fall in the category C3 (CEAP classification) and beyond. As the procedure (endovenous laser ablation [EVLA]) needed in such patients would require multiple needle punctures to give tumescent anaesthesia along the dilated veins, it warrants the need of an effective anaesthetic technique that provides adequate sedation and analgesia in a conscious patient with early postoperative recovery and discharge in a daycare facility.

Methods In the operating room, all patients received oxygen by ventimask fiO2 0.5 followed by premedication with midazolam 20μg/kg and paracetamol 1 gm intravenously. Patients were administered Nalbuphine 50μg/kg. Propofol bolus(0.75 mg/kg) followed by an infusion at 0.015 mg/kg/min was started. Ultrasound guided tumescent anaesthesia was given with an infuser intermittently. Sedation was monitored using Modified Ramsay Sedation Scale (MRSS) and propofol infusion was accordingly titrated to achieve MRSS score 2–4. Behavioral Pain Scale-Non-intubated (BPS-NI) was used to assess intraoperative pain score. Vital parameters (BP, HR, ECG, RR and SpO2) were observed. Patients were monitored and assessed post-procedure in terms of any complication, patient and surgeon satisfaction (Likert scale) and discharge time.

Results All 60 patients achieved adequate sedation (MRSS score 2–4), 58/60 patients achieved optimal pain relief (BPS-NI 4). None of the patients had any intra- or post-procedure complications. Both patient and surgeon satisfaction was high on Likert Scale. Mean time to discharge post procedure was 5.2±0.2 hours.

Conclusions Nalbuphine/Propofol based conscious sedation along with tumescent anaesthesia can be used as a safe and effective approach for patients undergoing EVLA in daycare facilities.

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