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When one liter does not equal 1000 milliliters: implications for the tumescent technique
W P Coleman1, T C Flynn, K M Coleman
1Department of Dermatology, Tulane University School of Medicine, New Orleans, Louisiana 70112-2699, USA.
Summary
Tumescent anesthesia solutions often contain more fluid than labeled, impacting lidocaine concentration. Surgeons should verify volumes and concentrations for accurate liposuction anesthesia.
Area of Science:
- Dermatologic Surgery
- Anesthesiology
- Pharmaceutical Compounding
Background:
- Tumescent anesthesia is crucial for liposuction.
- It involves large volumes of dilute lidocaine with epinephrine.
- Accurate formulation is essential for effective liposuction.
Purpose of the Study:
- Determine actual fluid volumes in 1 L saline bags.
- Calculate volumes in 50 cc lidocaine stock solutions.
- Measure fluid retained by peristaltic pump tubing.
Main Methods:
- Measured saline volumes from 1 L IV bags (3 manufacturers).
- Calculated fluid retained by peristaltic pump tubing.
- Quantified lidocaine in 50 ml stock bottles (various manufacturers/lots).
Main Results:
- 1 L saline bags averaged 1051 ml (1033-1069 ml).
- 50 ml lidocaine bottles averaged 54 ml (52.5-55 ml).
- Peristaltic pump tubing retained 46-146 ml of anesthetic.
Conclusions:
- Saline bags and lidocaine bottles exceed labeled volumes.
- Preparation methods can increase total tumescent fluid volume by 11-16%.
- Lidocaine concentrations may decrease by 10-14% due to extra fluid.