The Tumescent Technique: The Effect of High Tissue Pressure and Dilute Epinephrine on Absorption of Lidocaine

Tumescent technique without epinephrine for endovenous laser therapy and serum lidocaine concentration

“…16,17 The exact mechanism by which large doses of lidocaine used in tumescent liposuction result in moderate plasma concentration levels is still unknown but appears to be multifactorial and to encompasses both the unique composition of the solution and the surgical procedure. 3,4,18 The primary difference in tumescent lidocaine appears to be the highly dilute solution. Although there is no "standard concentration," the solution is composed of diluted lidocaine ranging between 0.05% and 0.1% with the addition of a vasoconstrictor (epinephrine 1 mg/L).…”

“…The relative concentration of lidocaine to the epinephrine may also play an important role in determining whether the vasoconstrictor affects lidocaine absorption. 4 Furthermore, the surgical technique may contribute to the delayed absorption with elevated pressure and lipectomy. The solution is slowly injected during 30 to 45 minutes into a relatively high volume of avascular adipose tissue with an intrinsic ability to sequester 1 mg of lidocaine per gram of adipose tissue.…”

“…For the liposuction procedure, "megadoses" several-fold greater than the maximum recommended dose have been administered. [2][3][4] Investigators have studied the plasma concentration relative to injection time for tumescent liposuction to determine peak plasma concentrations and rate of absorption after the megadose injection. 2-4 On the basis of data from these clinical investigations, the relatively "low dose" of lidocaine administered for EVLT procedures has been considered safe.…”

“…[2][3][4] Investigators have studied the plasma concentration relative to injection time for tumescent liposuction to determine peak plasma concentrations and rate of absorption after the megadose injection. [2][3][4] On the basis of data from these clinical investigations, the relatively "low dose" of lidocaine administered for EVLT procedures has been considered safe. However, none of these investigations were evaluations of the serum concentration after tumescent lidocaine injection for an EVLT procedure.…”

Liposuction: contemporary issues for the anesthesiologist

“…Power liposuction uses a reciprocating cannula to remove fat [11], whereas ultrasound-assisted liposuction is a modified procedure that uses ultrasonic energy delivery to enhance traditional liposuction [12]. High-pressure infusion has been investigated with pressures near 300 mmHg in the subcutaneous tissues during injection of the solution, but this method has not been shown to affect systemic lidocaine absorption [13]. However, these procedures are beyond the scope of this paper.…”