Efficacy of tumescent local anesthesia with variable lidocaine concentration in 3430 consecutive cases of liposuction

Habbema, Louis

doi:10.1016/j.jaad.2009.09.004

Cited by 31 publications

(6 citation statements)

References 21 publications

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“…[17] The concentration is decreased to 500 mg/L of normal saline in less sensitive areas such as the thighs. Louis Habbema[18] has reported in a series of 3,430 liposuction procedures that a maximum lignocaine concentration of 500 mg/L of normal saline solution allows infusion of a large volume of wetting solution, without any risk of lignocaine toxicity.…”

Section: Historical Backgroundmentioning

confidence: 99%

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Liposuction: Anaesthesia challenges

2011

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Liposuction is one of the most popular treatment modalities in aesthetic surgery with certain unique anaesthetic considerations. Liposuction is often performed as an office procedure. There are four main types of liposuction techniques based on the volume of infiltration or wetting solution injected, viz dry, wet, superwet, and tumescent technique. The tumescent technique is one of the most common liposuction techniques in which large volumes of dilute local anaesthetic (wetting solution) are injected into the fat to facilitate anaesthesia and decrease blood loss. The amount of lignocaine injected may be very large, approximately 35-55 mg/kg, raising concerns regarding local anaesthetic toxicity. Liposuction can be of two types according to the volume of solution aspirated: High volume (>4,000 ml aspirated) or low volume (<4,000 ml aspirated). While small volume liposuction may be done under local/monitored anaesthesia care, large-volume liposuction requires general anaesthesia. As a large volume of wetting solution is injected into the subcutaneous tissue, the intraoperative fluid management has to be carefully titrated along with haemodynamic monitoring and temperature control. Assessment of blood loss is difficult, as it is mixed with the aspirated fat. Since most obese patients opt for liposuction as a quick method to lose weight, all concerns related to obesity need to be addressed in a preoperative evaluation.

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Section: Historical Backgroundmentioning

confidence: 99%

“…Pneumatic compression devices are used for large-volume liposuction and for procedures lasting more than an hour, to prevents deep vein thrombosis (DVT). [18]…”

Section: Anaesthesia Techniquementioning

confidence: 99%

Liposuction: Anaesthesia challenges

2011

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“…In tumescent liposuction, judicious waiting (10.0–60.0 min) is the norm 47–49 . This improves hypoperfusion and hydrodissection, making suction easier 49 .…”

Section: Resultsmentioning

confidence: 99%

How long to wait after local infiltration anaesthesia: systematic review

Bajwa,

Bashir,

Bajwa

et al. 2023

BJS Open

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Background Conflicting evidence exists regarding the optimal waiting time for stable analgesic and vasoconstrictive effects after local infiltration of lidocaine with epinephrine. An objective review is needed to dispel surgical dogma. Methods This systematic review (PROSPERO ID: CRD42022362414) included RCTs and prospective cohort studies. Primary outcomes were (1) onset of analgesia and (2) onset of stable hypoperfusion, assessed directly, or measured indirectly using perfusion imaging. Other data extracted include waiting strategies, means of outcome assessment, anaesthetic concentrations, volume/endpoint of infiltration, and injection sites. Methodological quality was evaluated using the Cochrane risk-of-bias tool for randomized trials. Articles describing waiting strategies were critically appraised by the Joanna Briggs Institute tools. Results Twenty-four articles were analysed, comprising 1013 participants. Ten investigated analgesia onset. Their pooled mean was 2.1 min (range 0.4–9.0 min). This varied with anatomic site and targeted nerve diameter. Fourteen articles investigated onset of stable hypoperfusion. Four observed bleeding intraoperatively, finding the minimum time to hypoperfusion at 7.0 min in the eyelid skin and 25.0 min in the upper limb. The ten remaining studies used perfusion imaging, reporting a wide range of results (0.0–30.0 min) due to differences in anatomic sites and depth, resolution and artefacts. Studies using near-infrared reflectance spectroscopy and hyperspectral imaging correlated with clinical observations. Thirteen articles discussed waiting strategies, seven relating to large-volume tumescent local infiltration anaesthesia. Different waiting strategies exist for emergency, arthroscopic and cosmetic surgeries, according to the degree of hypoperfusion required. In tumescent liposuction, waiting 10.0–60.0 min is the norm. Conclusion Current literature suggests that around 2 min are required for most patients to achieve complete analgesia in all sites and with all anaesthesia concentrations. Waiting around 7 min in eyelids and at least 25 min in other regions results in optimal hypoperfusion. The strategies discussed inform decisions of when and how long to wait.

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“…In tumescent local anesthesia, high quantities of dilute lidocaine (0.05-0.1 %) are infused into the subcutaneous tissue until the area becomes firm and swollen [32,31]. Common uses in dermatologic surgery include dermabrasion, laser resurfacing, hair transplantation, reconstructive surgery, and liposuction [33].…”

Section: Lidocaine Toxicitymentioning

confidence: 99%

Error Avoidance in Dermatologic Surgery

Decker

Lawrence

2015

Curr Derm Rep

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Surgical errors pose a significant source of morbidity, mortality, and expense within the health care system. While rates of errors within dermatologic surgery are low, there are certain areas of dermatologic surgery that are more prone to errors than others. These include site identification, specimen labeling, triage, lidocaine toxicity, needle sticks, electrosurgery, and laser surgery. Within these areas, continued research is being done to identify the source of the errors and establish protocols to minimize the risk.

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Efficacy of tumescent local anesthesia with variable lidocaine concentration in 3430 consecutive cases of liposuction

Cited by 31 publications

References 21 publications

Liposuction: Anaesthesia challenges

Liposuction: Anaesthesia challenges

How long to wait after local infiltration anaesthesia: systematic review

Error Avoidance in Dermatologic Surgery

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