Tumescent Anesthesia

A technique of local anesthesia most commonly used by plastic surgeons during liposuction procedures involves the subcutaneous injection of large volumes of dilute local anesthetic in combination with epinephrine and other agents. Total doses of lidocaine ranging from 35 to 55 mg/kg have been reported to produce safe plasma concentrations, which may peak more than 8 to 12 hours after infusion. Despite these seemingly huge doses, very good outcomes have been reported in several case series.^[96] Conversely, there have been several recent case series of cardiac arrest and death during plastic surgical procedures in which multiple risk factors, including high local anesthetic concentrations, may have contributed to the patients' instability and deterioration. The factors governing uptake and clearance from this method of local anesthetic delivery deserve further study. Clinicians should use great caution when administering additional local anesthetics by infiltration or other routes for at least 12 to 18 hours after the use of this technique.