Intraoperative use of bupivacaine for tumescent liposuction: the Robert Wood Johnson experience

Bupivacaine anesthetic is commonly used as a wetting solution additive in tumescent liposuction, but its routine use remains controversial because of a lack of evidence in the current literature.

In accordance with local institutional review board regulations, a retrospective chart review was conducted of liposuction cases performed from 1997 to 2007 at Robert Wood Johnson University Hospital in New Brunswick, New Jersey. The primary endpoint was adverse perioperative events. Secondary endpoints included length of postanesthesia care unit stay and length of total postoperative hospital stay.

Eighty-seven cases were analyzed and two subsets of patients were identified. In group 1, 24 patients were compared who underwent liposuction as the primary procedure and received bupivacaine, lidocaine, or no additive in their wetting solution. No adverse events were encountered and the average length of stay was not significantly different. In group 2, 20 patients were compared who underwent abdominoplasty and liposuction and received bupivacaine or no additive in their wetting solution. No adverse events occurred and patients receiving bupivacaine had a significantly shorter average length of stay, 19 hours versus 36 hours, compared with controls (p = 0.015).

A review of the experience at Robert Wood Johnson University Hospital reveals that the intraoperative use of bupivacaine for tumescent liposuction in 27 cases appeared to be as safe as other tumescent additives. There did not appear to be a significant difference in the incidence of adverse events or postoperative length of stay for patients who underwent liposuction with bupivacaine compared with other wetting solutions. Among a subset of patients who underwent concurrent abdominoplasty and liposuction procedures, patients who received bupivacaine spent significantly less time in the hospital postoperatively than those who did not receive it. Conducting future prospective studies involving larger samples among multiple centers is an essential next step to confirm these findings.