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Semin Plast Surg 2006; 20(4): 219-224
DOI: 10.1055/s-2006-951579
Copyright © 2006 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA.

Optimal Use of Local Anesthetics and Tumescence

Kyle P. Gordley1 , C. Bob Basu1
  • 1Division of Plastic Surgery, Baylor College of Medicine, Houston, Texas
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Publication History

Publication Date:
18 October 2006 (online)

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ABSTRACT

It is mandatory for the cosmetic surgeon to use local anesthesia in a safe and effective manner. Current trends to perform more procedures in the office setting necessitate that the surgeon become facile with achieving anesthesia while minimizing complications. In a related theme, the use of tumescence during liposuction deserves respect, despite the ease with which it is applied. Too many unnecessary complications occur as a result of its careless use, resulting in a mortality rate higher than expected for an elective cosmetic procedure. Our goal is to describe the necessary characteristics, pharmacokinetics, physiologic effects, and overall safety guidelines for use of local anesthesia and tumescence. In addition, we highlight risk factors, newer anesthetics, and new methods for pain control.

KEYWORDS

Local anesthesia - safety guidelines - tumescence - liposuction

REFERENCES

  • 1 Grazer F M, deJong R H. Fatal outcomes from liposuction: census survey of cosmetic surgeons.  Plast Reconstr Surg. 2000;  105 436-446
    PubMedGoogle Scholar
  • 2 Stricharz G R. Neural physiology and local anesthetic action. In: Cousins MJ, Bridenbaigh PO Neural Blockade in Clinical Anesthesia and Management of Pain. Philadelphia, PA; JB Lippincott 1988: 47-110
    Google Scholar
  • 3 Koay J, Orengo I. Application of local anesthetics in dermatologic surgery.  Dermatol Surg. 2002;  28 143-148
    CrossrefPubMedGoogle Scholar
  • 4 Auletta M J. Local anesthesia for dermatologic surgery.  Semin Dermatol. 1994;  13 35-42
    PubMedGoogle Scholar
  • 5 Rao R B. Deaths related to liposuction.  N Engl J Med. 1999;  340 1471-1475
    CrossrefPubMedGoogle Scholar
  • 6 Soltesz E G. Emergent cardiopulmonary bypass for bupivacaine cardiotoxicity.  J Cardiothorac Vasc Anesth. 2003;  17 357-358
    CrossrefPubMedGoogle Scholar
  • 7 Atanassoff P G. Ropivacaine 0.2% and lidocaine 0.5% for intravenous regional anesthesia in outpatient surgery.  Anesthesiology. 2001;  95 627-631
    PubMedGoogle Scholar
  • 8 Lalonde D, Bell M, Benoit P et al.. A multicenter prospective study of 3,110 consecutive cases of elective epinephrine use in the fingers and hand: the Dalhousie Project clinical phase.  J Hand Surg [Am]. 2005;  30 1061-1067
    CrossrefPubMedGoogle Scholar
  • 9 Chazalon P, Tourtier J P, Villevielle T et al.. Ropivacaine-induced cardiac arrest after peripheral nerve block: successful resuscitation.  Anesthesiology. 2003;  99 1449-1451
    CrossrefPubMedGoogle Scholar
  • 10 Picture obtained from I-flow Corporation On-Q Pump Product Website. http://www.iflow.com
    Google Scholar
  • 11 Pacik P T, Werner C, Jackson N, Lobsitz C. Pain control in augmentation mammaplasty: the use of indwelling catheters in 200 consecutive patients.  Plast Reconstr Surg. 2003;  111 2090-2096
    PubMedGoogle Scholar
  • 12 Lu L, Fine N. The efficacy of continuous local anesthetic infiltration in breast surgery: reduction mammaplasty and reconstruction.  Plast Reconstr Surg. 2005;  115 1927-1934
    CrossrefPubMedGoogle Scholar
  • 13 Mentz H A. Use of a regional infusion pump to control postoperative pain after an abdominoplasty.  Aesthetic Plast Surg. 2005;  29 415-421
    CrossrefPubMedGoogle Scholar
  • 14 Klein J A. Tumescent technique for regional anesthesia permits lidocaine doses of 35 mg/kg for liposuction: peak plasma lidocaine levels are diminished and delayed 12 hours.  J Dermatol Surg Oncol. 1990;  16 248-263
    CrossrefPubMedGoogle Scholar
  • 15 American Society of Plastic Surgeons .2001 Procedural Statistics Report. Arlington Heights, IL; American Society of Plastic Surgeons 2001
    Google Scholar
  • 16 Ostad A, Kageyama N, Moy R L. Tumescent anesthesia with a lidocaine dose of 55 mg/kg is safe for liposuction.  Dermatol Surg. 1996;  22 921-927
    CrossrefPubMedGoogle Scholar
  • 17 Samdel F, Amland P F, Bugge J F. Blood loss during liposuction using the tumescent technique.  Aesthetic Plast Surg. 1994;  18 157-160
    CrossrefPubMedGoogle Scholar
  • 18 Pitman G H, Aker J S, Tripp Z D. Tumescent liposuction.  Clin Plast Surg. 1996;  23 633-641
    CrossrefPubMedGoogle Scholar
  • 19 de Jong R H. Local Anesthetics. St Louis, MO; Mosby-Year Book 1994
    Google Scholar
  • 20 Iverson R E, Lynch D J. APSP Committee on Patient Safety. Practice advisory on liposuction.  Plast Reconstr Surg. 2004;  113 1478-1496
    PubMedGoogle Scholar
  • 21 Fodor P B. Defining wetting solutions in lipoplasty.  Plast Reconstr Surg. 1999;  103 1519-1520
    PubMedGoogle Scholar
  • 22 Task ASPRS Force on Lipoplasty .J.G. Bruner (Chair). Brief Statement. (Revised 3/31/98). Arlington Heights, IL; American Society of Plastic and Reconstructive Surgeons 1998
    Google Scholar
  • 23 Kenkel J M, Lipschitz K H, Shepherd G et al.. Pharmacokinetics and safety of lidocaine and monoethylglycinexylidide in liposuction: a microdialysis study.  Plast Reconstr Surg. 2004;  114 516-524
    PubMedGoogle Scholar
  • 24 Trott S A, Beran S J, Rohrich R J et al.. Safety considerations and fluid resuscitation in liposuction: an analysis of 53 consecutive patients.  Plast Reconstr Surg. 1998;  102 2220-2229
    CrossrefPubMedGoogle Scholar
  • 25 Fodor P B. Wetting solutions in aspirate lipoplasty: A plea for safety in liposuction [editorial].  Aesthetic Plast Surg. 1995;  19 379-380
    PubMedGoogle Scholar
  • 26 Kenkel J M. Hemodynamic physiology and thermoregulation in liposuction.  Plast Reconstr Surg. 2004;  114 503-513
    PubMedGoogle Scholar
  • 27 Newall G, Ruiz-Razura A. A retrospective study on the use of a low-molecular-weight heparin for thromboembolism prophylaxis in large-volume liposuction and body contouring procedures.  Aesthetic Plast Surg. 2006;  30 86-95
    CrossrefPubMedGoogle Scholar
  • 28 Platt M S. Deaths associated with liposuction: case reports and review of the literature.  J Forensic Sci. 2002;  47 205-207
    PubMedGoogle Scholar
  • 29 Cardenas-Camarena L. Lipoaspiration and its complications: a safe operation.  Plast Reconstr Surg. 2003;  112 1435-1441
    PubMedGoogle Scholar

C. Bob BasuM.D. M.P.H. 

Division of Plastic Surgery, Baylor College of Medicine

1709 Dryden, Suite 1600, BCM Mail Stop: 630, Houston, TX 77030

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