Prilocaine Plasma Levels and Methemoglobinemia in Patients Undergoing Tumescent Liposuction Involving Less Than 2,000 ml

Liposuction is one of the most popular treatment modalities in aesthetic surgery with certain unique anaesthetic considerations. Liposuction is often performed as an office procedure. There are four main types of liposuction techniques based on the volume of infiltration or wetting solution injected, viz dry, wet, superwet, and tumescent technique. The tumescent technique is one of the most common liposuction techniques in which large volumes of dilute local anaesthetic (wetting solution) are injected into the fat to facilitate anaesthesia and decrease blood loss. The amount of lignocaine injected may be very large, approximately 35-55 mg/kg, raising concerns regarding local anaesthetic toxicity. Liposuction can be of two types according to the volume of solution aspirated: High volume (>4,000 ml aspirated) or low volume (<4,000 ml aspirated). While small volume liposuction may be done under local/monitored anaesthesia care, large-volume liposuction requires general anaesthesia. As a large volume of wetting solution is injected into the subcutaneous tissue, the intraoperative fluid management has to be carefully titrated along with haemodynamic monitoring and temperature control. Assessment of blood loss is difficult, as it is mixed with the aspirated fat. Since most obese patients opt for liposuction as a quick method to lose weight, all concerns related to obesity need to be addressed in a preoperative evaluation.

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“…Tumescent solution with prilocaine has not been associated with elevated plasma prilocaine levels or methemoglobinemia. [2425]…”

Section: Historical Backgroundmentioning

confidence: 99%

Liposuction: Anaesthesia challenges

2011

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“…Among the more recent reports are methemoglobinemia due to prolonged exposure to prilocaine for liposuction [94], topical benzocaine [95][96][97], and celecoxib [98]. All these substrates have an ar- omatic amine that could be converted to a phenylhydroxylamine (Fig.…”

Section: Acquired Methemoglobinemiamentioning

confidence: 99%

Methemoglobin—It's not just blue: A concise review

Umbreit¹

2006

American J Hematol

329

280

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Hemoglobin has functions besides carrying oxygen to the tissues, and regulates vascular tone and inflammation via a redox couple with methemoglobin. Hemoglobin has iron in the reduced valance Fe(II) and methemoglobin has iron in the oxidized valance Fe (III), with a free energy capable of producing water from oxygen. In generating methemoglobin the couple functions as a nitrite reductase. The degree of oxidation of hemoglobin senses the oxygen level in the blood and uses its ability to produce nitric oxide from nitrite to control vascular tone, increasing blood flood when the proportion of oxygenated hemoglobin falls. Additional cardiovascular damage is produced by methemoglobin mediated oxidation of light density lipoproteins, accelerating arteriosclerosis. In addition, the release of heme from methemoglobin is an important factor in inflammation. These physiologic functions are paralleled by the well-described role in the oxidation of various drugs resulting in methemoglobinemia. Am. J. Hematol. 82:134-144, 2007. V V C 2006 Wiley-Liss, Inc.

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“…An alternative approach to prevent lidocaine toxicity is to use different local anesthetics. 21,22 However, with the low concentrations of lidocaine that we currently use and its proven safety, 16 there seems to be little further incentive to search for other strategies. Although extremely rare, lidocaine allergy could be a reason to replace lidocaine by another anesthetic.…”

Section: Discussionmentioning

confidence: 98%

Efficacy of tumescent local anesthesia with variable lidocaine concentration in 3430 consecutive cases of liposuction

Habbema

2010

Journal of the American Academy of Dermatology

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Prilocaine Plasma Levels and Methemoglobinemia in Patients Undergoing Tumescent Liposuction Involving Less Than 2,000 ml

Cited by 34 publications

References 19 publications

Liposuction: Anaesthesia challenges

Liposuction: Anaesthesia challenges

Methemoglobin—It's not just blue: A concise review

Efficacy of tumescent local anesthesia with variable lidocaine concentration in 3430 consecutive cases of liposuction

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