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Tumescent anaesthesia.

Patrick H Conroy¹, James O'Rourke

¹Department of Anaesthesia and Intensive Care Medicine, Adelaide, Meath & National Children's Hospital, Tallaght, Dublin 24, Ireland. P_W_C@hotmail.com

The Surgeon : Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland

|February 5, 2013

Summary

This summary is machine-generated.

Tumescent anesthesia, using dilute local anesthetic with epinephrine and sodium bicarbonate, offers safe and effective pain control for various surgeries. Its slow absorption minimizes blood loss and provides prolonged pain relief, with an excellent safety record.

Keywords:

Anaesthetics Epinephrine Local anaesthesia Local anaesthetics Pharmacokinetics Sodium bicarbonate Tumescent anaesthesia

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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.