Observation of Pain During Radiofrequency Ablation of Saphenous Vein，and Analysis of Related Factors

Objective: This study is a single-center prospective observational study, which recorded the pain scores of patients at four time nodes during surgery (puncture and catheterization, injection of swelling fluid, radiofrequency generator work, and end of surgery), and analyzed the correlation between intraoperative pain and age, gender, BMI and other factors, so as to summarize and improve the details of surgery and reduce patients' intraoperative pain.

Study Overview

• Status: Completed
• Conditions: Vascular Diseases, Peripheral; Venous Insufficiency of Leg; Varicose Veins of Lower Limb
• Intervention / Treatment: Procedure: VAS scores of the puncture

Detailed Description

Although the global vascular surgeons have made significant progress in the study of RFA in the treatment of VVs, there are still many unknown areas to be explored, and the current research mainly focuses on the surgical effect of RFA and related complications, while the research on intraoperative pain is relatively scarce. First of all, RFA does not have a clear definition of intraoperative pain in the treatment of varicose veins of the lower extremities, so it has not received enough attention in clinical practice, and many doctors regard the success of surgery as the end point of treatment, but ignore the impact of intraoperative pain on the patient's surgical experience. In addition, with the continuous progress of varicose vein surgery of the lower extremities, the anesthesia method has also changed from general anesthesia to combined spinal-epidural block to today's local anesthesia, the swollen anesthetic solution is the main anesthetic drug used in RFA surgery, and the infiltration of the swollen anesthetic fluid around the saphenous vein is the key to the success of RFA, but paradoxically, this is also the most intense part of the patient's pain, the swollen fluid is usually a crystalloid solution containing local anesthetic and epinephrine, which is acidic in nature, which is also the main reason for the "tingling" during skin infiltration , A Cochrane review noted that adjusting the pH of lidocaine solution by adding sodium bicarbonate significantly reduced the pain reported on a 10 cm visual analogue scale (VAS) during skin infiltration, and that the temperature of the swollen anesthetic solution also had an effect on pain during skin infiltration, Bell et al. and Alonso et al. In a prospective randomized controlled trial, it was found that heating the local anesthetic solution to 37°C and 42°C reduced pain sensation, and heating the local anesthetic solution containing epinephrine to near body temperature was effective in reducing the pain of local anesthetic infiltration in patients, however, in a randomized clinical trial in 2018, patients were divided into cold swollen fluid group (4 °C) and room temperature swollen fluid group (24 °C), and the authors found that patients in the cold swollen fluid group had less pain during and after RFA, The amount of postoperative analgesics was significantly reduced. Therefore, the patient's pain during RFA has become a problem that we must pay attention to, and the operator should pay attention to the details and pay attention to the patient's intraoperative condition during RFA, so as to reduce the patient's intraoperative pain and give the patient a better surgical experience.

• Study Type: Observational
• Enrollment (Actual): 155

Contacts and Locations

Study Locations

• China
  • Sichuan
    • Chengdu, Sichuan, China, 610000
      • Hospital of Chengdu University of Traditional Chinese Medicine

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

• Sampling Method: Probability Sample

Study Population

Patients diagnosed with primary VVs from April 2023 to September 2023 who were admitted to the hospital and underwent RFA treatment for the main trunk of the saphenous vein

Description

Inclusion Criteria:

1. Age≥ 18 years old, ≤ 90 years old;
2. the patient's life expectancy is greater than 12 months;
3. The clinical diagnosis is primary VVs, CEAP classification C2-C6, and the GSV segment needs to be treated, including pain, burning sensation, heaviness, fatigue, itchy skin, night cramps and other clinical symptoms;
4. Doppler ultrasound confirmed that the diameter of GSV was greater than 3mm and less than 12mm when standing;
5. Doppler ultrasound confirms that GSV is located in the saphenofascia or the distance between GSV and the skin surface is >1cm;
6. radiofrequency ablation treatment only for unilateral GSV walking area;
7. The patient is willing to cooperate with the completion of the examination specified in the protocol.

Exclusion Criteria:

1. GSV thrombosis, or combined with deep vein thrombosis, or previous history of deep vein thrombosis and pulmonary embolism;
2. patients with recurrence after prior VVs-related surgery (C2r);
3. the GSV trunk is severely distorted, and it is expected that the catheter will not be able to pass;
4. Severe ischemia of the lower limbs, Ankle brachial pressure index (ABPI) < 0.8;
5. Known allergy to the drugs and device materials involved in the study;
6. Previously implanted with a pacemaker or defibrillator, and currently receiving regular anticoagulation therapy (such as warfarin, heparin);
7. Pregnant or lactating females;
8. Patients who are unable or unwilling to participate in the study;
9. Participating in the research of other drugs or devices;
10. Skin malignancies other than non-melanoma that are being treated;
11. daily use of narcotic drugs or non-steroidal anti-inflammatory drugs to control pain caused by venous disease;
12. The investigator judged that endovenous treatment was not suitable;

Study Plan

How is the study designed?

Number of groups / cohorts

1

Cohorts and Interventions

Group / Cohort

Intervention / Treatment

Observation of Pain During Radiofrequency Ablation of Saphenous Vein，and Analysis of Related Factors; Among the 155 patients were evaluated by our team with CEAP grading and ultrasound measurements to record the diameter of the saphenous vein before surgery, and the procedure of radiofrequency ablation of the saphenous vein trunk supplemented with sclerotherapy was applied to record the data of the operating room temperature, puncture site, and the VAS scores of the puncture and tube placement, injection of the swelling fluid, radiofrequency generator, and the end of the procedure. The patients' intraoperative pain scores were descriptively analyzed to assess the degree of intraoperative pain, and non，parametric tests were applied to analyze the correlation between preoperative and intraoperative factors and intraoperative pain.

Procedure: VAS scores of the puncture

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Puncture catheterization	The pain during puncture and catheterization mainly comes from needle breakage, local anesthetic infiltration and vascular sheath insertion, the 7F vascular puncture sheath group was used in this study, the diameter of the puncture needle is 1.27mm, the pain during skin puncture is stronger than that of the syringe needle used for intravenous or intramuscular injection, there is a well-designed randomized controlled use of an automatic injection device to standardize the injection parameters, and the use of smaller needles also forces the injector to slow down the injection rate, which can reduce the pain of the patient	At the time of surgery
Inject swollen fluid	In this study, a 0.7mm needle was used to inject lidocaine into the skin around the puncture point, which can be replaced with a 0.5mm needle to slow down the injection rate of lidocaine, reduce the stinging sensation of the patient, and place the vascular sheath after the local anesthetic infiltrates the skin, which can slightly reduce the pain of the vascular sheath entering the blood vessel through the skin. Similarly, a 0.7mm needle is used to inject swelling fluid from the puncture point along the main trunk of the saphenous vein, the longer the length of the patient's ablation vein, the number of skin breaks will increase, but the patient's pain will not increase with the accumulation of skin breaks, and the operator can reduce the pain of the patient's injection of swelling fluid by squeezing, pressing, stretching the skin, and inserting the needle vertically	At the time of surgery

Collaborators and Investigators

• Sponsor: Chengdu University of Traditional Chinese Medicine

Publications and helpful links

General Publications

• Kubat E, Unal CS, Geldi O, Cetin E, Keskin A. What is the optimal treatment technique for great saphenous vein diameter of >/=10 mm? Comparison of five different approaches. Acta Chir Belg. 2021 Apr;121(2):94-101. doi: 10.1080/00015458.2019.1684008. Epub 2019 Oct 25.
• Bozoglan O, Mese B, Eroglu E, Erdogan MB, Erdem K, Ekerbicer HC, Yasim A. Comparison of Endovenous Laser and Radiofrequency Ablation in Treating Varicose Veins in the Same Patient. Vasc Endovascular Surg. 2016 Jan;50(1):47-51. doi: 10.1177/1538574415625813. Epub 2016 Jan 14.
• Nandhra S, Wallace T, El-Sheikha J, Leung C, Carradice D, Chetter I. A Randomised Clinical Trial of Buffered Tumescent Local Anaesthesia During Endothermal Ablation for Superficial Venous Incompetence. Eur J Vasc Endovasc Surg. 2018 Nov;56(5):699-708. doi: 10.1016/j.ejvs.2018.05.017. Epub 2018 Jun 29.
• Cepeda MS, Tzortzopoulou A, Thackrey M, Hudcova J, Arora Gandhi P, Schumann R. Adjusting the pH of lidocaine for reducing pain on injection. Cochrane Database Syst Rev. 2010 Dec 8;(12):CD006581. doi: 10.1002/14651858.CD006581.pub2.
• Arendt-Nielsen L, Egekvist H, Bjerring P. Pain following controlled cutaneous insertion of needles with different diameters. Somatosens Mot Res. 2006 Mar-Jun;23(1-2):37-43. doi: 10.1080/08990220600700925.
• Egekvist H, Bjerring P, Arendt-Nielsen L. Pain and mechanical injury of human skin following needle insertions. Eur J Pain. 1999 Mar;3(1):41-49. doi: 10.1053/eujp.1998.0099.
• Gill HS, Prausnitz MR. Does needle size matter? J Diabetes Sci Technol. 2007 Sep;1(5):725-9. doi: 10.1177/193229680700100517.

Study record dates

Study Major Dates

• Study Start (Actual): July 1, 2024
• Primary Completion (Actual): September 1, 2024
• Study Completion (Actual): September 1, 2024

Study Registration Dates

• First Submitted: July 29, 2024
• First Submitted That Met QC Criteria: June 28, 2026
• First Posted (Actual): July 6, 2026

Study Record Updates

• Last Update Posted (Actual): July 6, 2026
• Last Update Submitted That Met QC Criteria: June 28, 2026
• Last Verified: July 1, 2024

More Information

Terms related to this study

• Keywords: Radiofrequency Ablation; visual analogue scale; intraoperative pain; Varicose veins of the lower extremities
• Additional Relevant MeSH Terms: Vascular Diseases; Cardiovascular Diseases; Peripheral Vascular Diseases
• Other Study ID Numbers: chengduUTCMvs6

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No