Local and Regional Anesthesia in Plastic Surgery: Safety Considerations and Management of Adverse Events

Abstract

Plastic surgery procedures rely on different approaches to local and regional anesthesia. Tumescent anesthesia (injection of large volumes of dilute local anesthetic, most commonly lidocaine) is used for liposuction and face-lift surgeries, while digital blocks are commonly used for hand surgeries. Traditional regional approaches (e.g., paravertebral or epidural blocks) have been used for breast augmentation. Local anesthetic systemic toxicity—and its associated symptoms—is the primary complication associated with plastic surgery regional anesthesia. Injection of rapidly absorbed local anesthetics into vascular areas heightens the risk. Topical anesthetics have also been implicated in local anesthetic toxicity. Other complications described following regional anesthesia for plastic surgery procedures include Horner syndrome, pneumothorax, direct injury to the nerve, block failure, and problems associated with infusion pumps. General considerations for avoiding local anesthetic toxicity for plastic surgery include use of epinephrine and appropriate local anesthetic doses, avoiding intravascular injection, and allowing sufficient time before reinjecting an area. Proper monitoring and an intervention plan in case of toxicity are also mandatory.