In patients undergoing endovenous radiofrequency ablation of varicose veins, topical anesthesia pretreatment is effective to alleviate the needle puncture pain during tumescent anesthesia.

A study was conducted to explore efficacy of topical anesthesia pretreatment (TAP)  for mitigating pain during tumescent anesthesia in people scheduled to undergo radiofrequency ablation (RFA).

In this double-blind, randomized controlled trial, 62 RFA treated participants were recruited and randomly segregated into the EMLA group (n = 32) and the placebo group (n = 30). The participants in the EMLA group were given TAP + lidocaine-prilocaine cream and the participants in the placebo group were given TAP + water-based cream.

The pain described by the participants on the visual analogue scale (VAS) at various time points during the procedure was the major outcome ascertained. The use of extra analgesia, expense, satisfaction level, complications, and the technical success rate were the secondary outcomes ascertained.

Venous clinical severity score (VCSS), CEAP classification, and baseline demographics were comparable between both groups. Compared to the placebo group, participants in the EMLA group experienced lower tumescent anesthetic needle puncture pain, as depicted in Table 1:

In this study, the pain scores of other time points were reported to be comparable. Compared to the non-pretreated area, lower pain was witnessed in EMLA pretreated area during needle puncture in the same patient, as shown in Table 2:

The placebo group didn't show similar phenomena. No statistical difference in technical success, expense, satisfaction level, and complications was observed between both groups. There was no utilization of extra analgesia in all the participants.

For conducting RFA of lower extremity varicose veins, routine utilization of TAP is suggested for minimizing needle puncture pain during tumescent anesthesia.