Objectives: Clinical experience suggested that preoperative infiltration of proposed avulsion sites with bupivacaine and adrenaline reduced bleeding associated with varicose vein surgery. This hypothesis was subjected to a randomized controlled trial.

Methods: Twenty patients undergoing bilateral long saphenous vein (LSV) stripping and avulsions were randomized to have one leg infiltrated with 0.25% bupivacaine and the other with 0.25% bupivacaine with adrenaline (1 in 200,000). Following induction of general anaesthesia, 10 mL of local anaesthetic was infiltrated into the groin and 20–30 mL over the marked varicosities down the leg. Bilateral PIN stripping and hook avulsions were performed. Operative blood loss was recorded for each leg and the area of strip-site and avulsion-site bruising was determined five days postoperatively.

Results: There was no difference in the numbers of avulsions between the legs receiving adrenaline (median 12, range 4–23) and controls (median 13, range 4–25), but adrenaline significantly reduced the operative blood loss (median 41 mL, range 17–122) compared with control legs (median 79 mL, range 28–210; P < 0.001, Wilcoxon). There was also a significant reduction in postoperative avulsion-site bruising (median 45 cm², range 13–101 compared with median 70 cm², range 34–221; P < 0.001). There was a smaller reduction in strip-site bruising (median 50 cm², range 14–128 compared with median 62 cm², range 21–141; P < 0.001).

Conclusions: Preoperative infiltration with bupivacaine and adrenaline is safe and reduces bleeding and bruising associated with varicose vein surgery.