Comparative Outcomes of Endovenous Thermal Ablation under General Anesthesia versus Spinal Anesthesia in Patients with Varicose Veins: A Prospective Comparative Study

Background: Endovenous thermal ablation (EVTA) is the current standard treatment for symptomatic varicose veins. While tumescent local anesthesia is preferred in high-resource settings, general anesthesia (GA) and spinal anesthesia (SA) remain commonly used in resource-limited environments. Comparative evidence between these modalities in EVTA is limited. Objectives: The objective of this study was to compare postoperative pain, recovery profile, perioperative outcomes, complications, patient satisfaction, and cost between GA and SA in patients undergoing EVTA. Methods: This prospective randomized controlled trial was conducted at a tertiary care center in Kathmandu, Nepal, over 12 months. One hundred adult patients with symptomatic primary varicose veins (CEAP C2–C6) undergoing radiofrequency ablation were randomized into GA ( n = 50) and SA ( n = 50) groups. The primary outcome was postoperative pain assessed using the Numerical Rating Scale at 6 and 24 h. Secondary outcomes included procedure duration, time to ambulation, hospital stay, complications, patient satisfaction, quality of life (Aberdeen Varicose Vein Questionnaire), return to normal activity, and treatment cost. Results: Postoperative pain scores were comparable between groups at all time points ( P > 0.05). Procedure duration and intraoperative hemodynamic events were similar. GA was associated with significantly earlier ambulation (138.5 vs. 190.6 min, P < 0.001) and shorter hospital stay (3.2 vs. 6.4 h, P < 0.001). However, GA had higher rates of postoperative nausea and vomiting (PONV) (32% vs. 6%, P < 0.001), whereas SA showed increased urinary retention (42% vs. 4%, P < 0.001). Treatment cost was significantly higher in the GA group. Patient satisfaction was higher with GA at discharge but similar at follow-up. Quality of life improved significantly in both groups without intergroup differences. Vein occlusion rates at 3 months were identical (96%). Conclusion: Both GA and SA provide comparable pain control and procedural efficacy in EVTA. GA enables faster recovery but is associated with higher cost and PONV, whereas SA is more cost-effective but delays ambulation and increases urinary retention. Anesthesia choice should be individualized based on clinical and resource considerations.