Femoral Nerve Block Versus Low-Dose Spinal Anesthesia for Ambulatory Endovenous Laser Ablation: A Prospective Randomized Trial.

OBJECTIVES: This study aimed to compare the perioperative efficiency and recovery profiles of ultrasound-guided femoral nerve block (FNB) and low-dose spinal anesthesia in patients undergoing ambulatory endovenous laser ablation (EVLA) surgery. DESIGN: Prospective randomized study. SETTING: Ambulatory surgery setting. PARTICIPANTS: Forty patients scheduled for elective EVLA. INTERVENTIONS: Patients were prospectively randomized into 2 groups: low-dose spinal anesthesia with 6 mg hyperbaric bupivacaine (Group S, n = 20) or ultrasound-guided femoral nerve block with 20 mL of 1% lidocaine (Group F, n = 20). MEASUREMENTS AND MAIN RESULTS: The primary outcome was hospital discharge time. Secondary outcomes included time to surgical readiness, sensory and motor block regression, mobilization time, perioperative complications, hemodynamic stability, and patient satisfaction scores. Demographic and clinical characteristics were comparable between groups. Time from anesthetic administration to surgical readiness was significantly shorter in Group F than in Group S (7.70 ± 1.26 v 10.75 ± 1.61 minutes, p < 0.001). Patients receiving FNB demonstrated faster mobilization (152.5 [128.5-177.3] v 180 [161.3-190] minutes, p = 0.012) and shorter discharge times (167 [136.3-187.5] v 197.5 [180-210] minutes, p = 0.002). Sensory block regression occurred earlier in Group F (141.25 ± 30.90 v 161.25 ± 18.48 minutes, p = 0.019). The incidence of postoperative motor blockade was significantly lower in the femoral block group (35% v 70%, p = 0.027). Patient satisfaction scores were higher in Group F (4.60 ± 0.50 v 4.10 ± 0.71, p = 0.015). No major perioperative complications or significant hemodynamic differences were observed between groups. CONCLUSION: Ultrasound-guided femoral nerve block provided superior perioperative efficiency and recovery outcomes compared with low-dose spinal anesthesia in ambulatory EVLA. Faster mobilization, reduced motor blockade, and earlier discharge support FNB as an effective ERAS-compatible anesthetic strategy for modern ambulatory venous surgery.