Tumescent anaesthesia

Area of Science:

• Surgical Anesthesia
• Pharmacology

Background:

• Tumescent anesthesia involves injecting dilute local anesthetic with epinephrine and sodium bicarbonate into tissues.
• Initially used for liposuction, its applications have expanded to diverse surgical fields like vascular, breast, plastic, and ENT procedures.
• It is utilized in both hospital and office settings, sometimes as the sole anesthetic method.

Purpose of the Study:

• To review the principles and applications of tumescent anesthesia.
• To highlight its advantages, including reduced blood loss and pain management.
• To discuss the pharmacokinetic profile and safety of tumescent lidocaine.

Main Methods:

• Review of existing literature on tumescent anesthesia.
• Analysis of its application in various surgical specialties.
• Examination of the pharmacokinetic properties of tumescent lidocaine, including absorption and clearance.
• Discussion of safety considerations and dosage adjustments.

Main Results:

• Tumescent anesthesia reduces blood loss via epinephrine vasoconstriction and hydrostatic compression.
• Sodium bicarbonate alleviates injection pain.
• Lidocaine doses up to 35 mg/kg are safe for liposuction due to slow subcutaneous absorption.
• This slow absorption creates a depot effect, leading to delayed peak blood levels and extended postoperative analgesia.
• Hepatic clearance of lidocaine is efficient, maintaining safe systemic levels.

Conclusions:

• Tumescent anesthesia is a versatile and safe technique with a favorable safety profile.
• Understanding its unique pharmacokinetics is crucial for safe application, especially regarding dosage adjustments.
• The technique offers significant benefits in blood loss reduction and postoperative pain management across multiple surgical disciplines.