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
- 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
- 3
Koay J, Orengo I.
Application of local anesthetics in dermatologic surgery.
Dermatol Surg.
2002;
28
143-148
- 4
Auletta M J.
Local anesthesia for dermatologic surgery.
Semin Dermatol.
1994;
13
35-42
- 5
Rao R B.
Deaths related to liposuction.
N Engl J Med.
1999;
340
1471-1475
- 6
Soltesz E G.
Emergent cardiopulmonary bypass for bupivacaine cardiotoxicity.
J Cardiothorac Vasc Anesth.
2003;
17
357-358
- 7
Atanassoff P G.
Ropivacaine 0.2% and lidocaine 0.5% for intravenous regional anesthesia in outpatient
surgery.
Anesthesiology.
2001;
95
627-631
- 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
- 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
- 10 Picture obtained from I-flow Corporation On-Q Pump Product Website. http://www.iflow.com
- 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
- 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
- 13
Mentz H A.
Use of a regional infusion pump to control postoperative pain after an abdominoplasty.
Aesthetic Plast Surg.
2005;
29
415-421
- 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
- 15 American Society of Plastic Surgeons .2001 Procedural Statistics Report. Arlington
Heights, IL; American Society of Plastic Surgeons 2001
- 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
- 17
Samdel F, Amland P F, Bugge J F.
Blood loss during liposuction using the tumescent technique.
Aesthetic Plast Surg.
1994;
18
157-160
- 18
Pitman G H, Aker J S, Tripp Z D.
Tumescent liposuction.
Clin Plast Surg.
1996;
23
633-641
- 19 de Jong R H. Local Anesthetics. St Louis, MO; Mosby-Year Book 1994
- 20
Iverson R E, Lynch D J.
APSP Committee on Patient Safety. Practice advisory on liposuction.
Plast Reconstr Surg.
2004;
113
1478-1496
- 21
Fodor P B.
Defining wetting solutions in lipoplasty.
Plast Reconstr Surg.
1999;
103
1519-1520
- 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
- 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
- 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
- 25
Fodor P B.
Wetting solutions in aspirate lipoplasty: A plea for safety in liposuction [editorial].
Aesthetic Plast Surg.
1995;
19
379-380
- 26
Kenkel J M.
Hemodynamic physiology and thermoregulation in liposuction.
Plast Reconstr Surg.
2004;
114
503-513
- 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
- 28
Platt M S.
Deaths associated with liposuction: case reports and review of the literature.
J Forensic Sci.
2002;
47
205-207
- 29
Cardenas-Camarena L.
Lipoaspiration and its complications: a safe operation.
Plast Reconstr Surg.
2003;
112
1435-1441
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