Tumescent local anesthesia: Recommendations

Is the use of lidocaine in tumescent anesthesia safer than other anesthetics for the same procedure?
Lidocaine and prilocaine are both safe and recommended for use in tumescent local anesthesia for office-based liposuction. Use  of bupivacaine is not recommended for this use.
  • Use of prilocaine is not approved in the United States for this procedure as of the date of this publication. 

Strength of recommendation: A   Level of evidence: I, II


Does the volume and dose of lidocaine and epinephrine correlate with patient safety in tumescent anesthesia?
The addition of epinephrine to lidocaine is recommended and safe for use in tumescent local anesthesia for liposuction.

A maximum dose of 55 mg/kg of lidocaine with epinephrine has been demonstrated to be safe and can be used for tumescent local anesthesia for liposuction in patients weighing 43.6 – 81.8 kg. 
Strength of recommendation: A   Level of evidence: I, II


Does a slow infusion rate result in less pain, and/or better anesthetic effect, than fast infusion rates?
A maximum dose of 55 mg/kg of lidocaine with epinephrine has been demonstrated to be safe and can be used for tumescent local anesthesia for liposuction in patients weighing 43.6 – 81.8 kg. 

Strength of recommendation: A   Level of evidence: I


​Is there a measure of care better/safer than others to decrease symptoms of local anesthetic systemic toxicity for patients anesthetized using the tumescent technique?
  • The use of warm anesthetic solution and a slow infiltration rate is recommended to decrease patient discomfort during administration of tumescent local anesthesia.
  • Use of a slow infiltration rate to decrease patient discomfort during administration of tumescent local anesthesia 

Strength of recommendation: C   Level of evidence: III


Tumescent local anesthesia, which was developed by a dermatologist, uses the subcutaneous infiltration of large volumes of dilute anesthetic to produce swelling and firmness of the targeted areas.126 There is substantial evidence to support the safety of tumescent local anesthesia when used for office-based liposuction. There are no reports of death associated with liposuction performed under tumescent local anesthesia by dermatologists, and multiple studies estimate the rate of serious adverse events to be 0.04-0.16%.137-141 Lidocaine with epinephrine is the most commonly studied solution and has been shown to be effective at multiple concentrations.126 -131 


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