Eliminating Lidocaine from Large-Volume Tumescent Liposuction

Abstract

Introduction: The introduction of tumescent anesthesia in 1987 was a major milestone in liposuction history. The technique provided local anesthesia for large areas of liposuction as well as virtually eliminating significant blood loss. With the acceptance of tumescence as a standard in liposuction surgery, surgeons have begun infusing ever-increasing amounts of tumescent fluid and aspirating volumes of fat considered impossible to remove only a decade ago. Large-volume tumescent infusion delivered concomitantly large loads of lidocaine, almost an order of magnitude greater than the maximum load recommended in the Physicians' Desk Reference. Complications are inevitable with lidocaine levels this high. Large-volume liposuction can result in lidocaine toxicity with tumescent anesthesia. This study evaluated whether removing lidocaine from the tumescent formula increases the safety and extends the efficacy of large-volume liposuction by eliminating the danger of lidocaine toxicity. Methods and Materials: A retrospective review of 105 patients undergoing large-volume liposuction with a tumescent infusion of greater than 10 L was performed. A high incidence (71%) of nausea and vomiting was noted in 24 patients undergoing large-volume liposuction under tumescent anesthesia with Klein solution. Because of the possibility of toxicity, lidocaine was eliminated from the tumescent formula and anesthesia was provided with epidural block. Results: A total of 105 patients undergoing large-volume liposuction were studied; 24 had tumescent anesthesia and 81 had epidural anesthesia and tumescent infusion of epinephrine 1:1000 000 concentration without lidocaine. The incidence of nausea and vomiting dropped from 71% to 14% when lidocaine was removed. Conclusion: The possibility of toxicity is virtually eliminated when lidocaine is removed from the tumescent formula and when regional or general anesthesia is used. This allows the surgeon to infuse a greater volume of tumescent solution and remove a larger volume of fat with increased safety.