Tumescent anesthesia is a surgical technique for delivery of

local anesthesia Local anesthesia is any technique to induce the absence of sensation in a specific part of the body, generally for the aim of inducing local analgesia, that is, local insensitivity to pain, although other local senses may be affected as well. I ...

. It also makes the target tissue firm and turgid from absorbed water, which can aid certain procedures. It was originally devised for use in liposuction, but has since been applied to other surgical situations, including

plastic surgery Plastic surgery is a surgical specialty involving the restoration, reconstruction or alteration of the human body. It can be divided into two main categories: reconstructive surgery and cosmetic surgery. Reconstructive surgery includes cranio ...

burn A burn is an injury to skin, or other tissues, caused by heat, cold, electricity, chemicals, friction, or ultraviolet radiation (like sunburn). Most burns are due to heat from hot liquids (called scalding), solids, or fire. Burns occur mainl ...

care, and

vascular surgery Vascular surgery is a surgical subspecialty in which diseases of the vascular system, or arteries, veins and lymphatic circulation, are managed by medical therapy, minimally-invasive catheter procedures and surgical reconstruction. The specialt ...

. It is a relatively safe way to achieve extensive regional anesthesia of skin and subcutaneous tissue with a high total dose but a low risk of systemic toxicity. The subcutaneous infiltration of a large volume of very dilute

lidocaine Lidocaine, also known as lignocaine and sold under the brand name Xylocaine among others, is a local anesthetic of the amino amide type. It is also used to treat ventricular tachycardia. When used for local anaesthesia or in nerve blocks, li ...

and

epinephrine Adrenaline, also known as epinephrine, is a hormone and medication which is involved in regulating visceral functions (e.g., respiration). It appears as a white microcrystalline granule. Adrenaline is normally produced by the adrenal glands and ...

causes the targeted tissue to become swollen and firm, or tumescent, and permits otherwise painful procedures to be performed on patients without subjecting them to the inherent risks of

general anesthesia General anaesthesia (UK) or general anesthesia (US) is a medically induced loss of consciousness that renders the patient unarousable even with painful stimuli. This effect is achieved by administering either intravenous or inhalational general ...

, and with reduced blood loss due to the vasoconstriction induced by epinephrine. __TOC__

Agents and doses

The most common combination of agents used in tumescent anesthesia is

(0.05-0.10%) and

(1 ppm). For lidocaine, total doses of 35 mg/kg and 55 mg/kg have been reported as reasonably safe high-end doses, in the context of liposuction.

Prilocaine Prilocaine () is a local anesthetic of the amino amide type first prepared by Claes Tegner and Nils Löfgren. In its injectable form (trade name Citanest), it is often used in dentistry. It is also often combined with lidocaine as a topical p ...

is also widely used, although it is not formally approved for tumescent anesthesia in the USA. A combination of lidocaine/prilocaine has been used in radio frequency ablation of varicose veins, and has been suggested as appropriate for cases where a great volume of tumescent anesthesia is required. A double-blind randomized intraindividual study of lidocaine versus prilocaine in tumescent anesthesia for liposuction revealed no differences in efficacy or tolerability, except that lidocaine had a slightly more rapid onset of action. A clinician reported favorably on the use of

ropivacaine Ropivacaine ( rINN) is a local anaesthetic drug belonging to the amino amide group. The name ropivacaine refers to both the racemate and the marketed ''S''-enantiomer. Ropivacaine hydrochloride is commonly marketed by AstraZeneca under the brand n ...

for slow-infusion tumescent anesthesia, where ropivacaine provided local anesthesia for about twice as long as lidocaine.

Bupivicaine Bupivacaine, marketed under the brand name Marcaine among others, is a medication used to decrease feeling in a specific area. In nerve blocks, it is injected around a nerve that supplies the area, or into the spinal canal's epidural space. It ...

is not recommended by the American Academy of Dermatology due to a lack of data on its use.

References

External links

Tumescent Technique
Anesthesia {{treatment-stub