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By Amanda Godwin

A radiofrequency ablation patient recently reported that her procedure was painful and that she experienced no relief from the 0.1% lidocaine tumescent anesthesia she received prior to the procedure.

The patient was a 52-year-old, red-haired female hairstylist with complaints of leg cramps, leg aches and restless leg symptoms. Further questioning revealed that she had not responded to lidocaine at her dentist’s office either.

Why did she not respond to the lidocaine?

Case studies like the one mentioned above are a regular part of the online educational content provided exclusively by the American College of Phlebology (ACP) to serve as a free educational resource for its members.

These case studies, or “Case of the Month,” are submitted by medical practitioners to provide education scenarios reflective of the types of issues that venous and lymphatic medical professionals may encounter. The cases often highlight a particular venous or lymphatic disease state, treatment options, possible complications, and even non-clinical scenarios such as the medico-legal aspects of compounding.

Participating in and submitting a case is not limited to practicing physicians. Ultrasound technologists, nurses, mid-level providers, fellows, residents and students are encouraged to take part. The overall goal of the Case of the Month is to be an avenue for learning, a source of continuing medical education and self-assessment, and a forum to share interesting and educational cases with colleagues.

In the case of the lidocaine resistant patient, the physician learned that a mutation in the melanocortin 1 receptor protein (MC1R) may have a secondary effect on lidocaine resistance. This mutation often is found in individuals with red hair. For the patient’s second treatment, the physician used Marcaine (bupivacaine) tumescent anesthesia. The patient reported no pain or discomfort with the second procedure.

To read the full case and complete the course for credit, ACP members may go to the Online Education Center at While the Case of the Month is available only to ACP members, a variety of other certified courses are available through the ACP Online Education Center to everyone.

If you have an interesting case that you would like to submit as a case of the month, you can download the Case Guidelines and Submission Form at  thoraco-lumbar . VTN


Amanda Godwin is the senior marketing coordinator at the American College of Phlebology. She can be contacted by email at .

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