Safety of Liposuction Using Exclusively Tumescent Local Anesthesia in 3,240 Consecutive Cases

Abstract

Liposuction using exclusively TLA is a proven safe procedure provided that the existing guidelines are meticulously followed.

Larger Infiltration/Aspiration Volumes, Plasma/ Subcutaneous Fluid Lidocaine Levels and Quantitative Abdominal Tissue Accommodation After Water-Assisted Liposuction (WAL): Comparative Safety and Efficacy to Traditional Liposuction (TL)

“…In larger infiltration volume WAL or TL cases, however, patients must be provided with an available intravenous access site, be the recipient of prewarmed tumescent fluids, supported by a warming blanket and an anti-embolic calf/ankle pumps, and monitored fluid outputs with a urinary catheter. The information from this limited comparison of techniques does not significantly add to previously published data 4,6,10,15,50 , but confirms the safety profile during larger infiltration and liposuction cases under local anesthesia. Along with sound clinical judgment, both techniques may be performed safely under strict preoperative criteria, intraoperative fluid monitoring, and postoperative assessments for at least 12 hours.…”

“…In particular, safer outcomes have been reported when the physiologic impact of larger volume liposuction is understood in cases that are associated with significant fluid shifts, third space losses, and potential epinephrine and lidocaine side-effects and toxicities. In larger cases, superwet technique [28][29][30][31] is usually associated with the use of parenteral fluid maintenance and replacement with total intravenous or general anesthesia, while Klein's tumescent technique [6][7]10 recommends the elimination for parenteral fluid support or total intravenous/general anesthesia in large volume cases. With either technique, however, the issue of absorption of the tumescent fluid infiltrate is complicated by the removal of the infiltrate along with fat and blood during suctioning.…”

Estimated Maximal Safe Dosages of Tumescent Lidocaine

“…Years of worldwide experience have shown that 55 mg/kg tumescent lidocaine for liposuction is remarkably safe. 48,49 This dosage is safe most of the time. Multiple large surveys involving thousands of procedures have found no evidence of tumescent lidocaine toxicity at recommended dosages.…”

Liposuction: Where are We and Where are We Going?

“…Another advantage is the reduced need for intravenous administration of fluids perioperatively [19].…”