Tumescent local anesthesia (TLA) with a mixture of epinephrine and lidocaine hydrochloride (LH) is effective in stripping and ablating varicose veins in the lower extremities, and frequent skin punctures gives the patients pain many times. This report showed two cases (three limbs) of the incompetence of the small saphenous veins (SSVs) found in three limbs treated under peripheral nerve block anesthesia. In the first case, a 32-year-old man had skin ulcer at the left lower leg, and the ulcer was diagnosed as venous stasis ulcer caused by SSV reflex. Sciatic nerve and posterior femoral cutaneous nerve block were performed with 0.4% LH under the ultrasonic guidance. The incompetence of SSV was punctured at the center of posterior lower leg, and TLA agent was injected both along and around SSV under the ultrasonic guidance. Intravascular ablation was performed without pain. The patient was able to walk immediately after operation. There were no complications due to the peripheral nerve block. In the second case, a 71-year- old woman had bilateral varicose vein and dermatitis. Vein stasis dermatitis was diagnosed by finding bilateral SSV reflex. Sciatic nerve and posterior femoral cutaneous nerve block were performed by the same procedure described above. On the right limb, intravascular ablation was performed after the injection of TLA agent. On the left limb, SSV stripping was performed with the injection of TLA agent because of aneurysm at venous junction. The patient found no pain during operation and was able to walk immediately after operation. Low concentration LH was able to block only the sensory nerve, allowing the motor nerve to be healthy. Peripheral nerve block with a low concentration of LH was a useful and safe method for avoiding intraoperative pain at the varicose veins of the lower extremities.
