From the Guidelines
A recommended solution for 250 mL of tumescent fluid for liposuction is 250 mL of normal saline (0.9% sodium chloride) mixed with 25-50 mg of lidocaine (1% or 2% solution), 0.25-0.5 mg of epinephrine (1:1000 solution), and 2-4 mEq of sodium bicarbonate. This formulation provides adequate local anesthesia while minimizing bleeding during the procedure 1. When preparing this solution, it's essential to maintain sterile technique and to calculate the lidocaine dose carefully to avoid exceeding the maximum safe dose (55 mg/kg with epinephrine) as recommended by guidelines for office-based liposuction using tumescent local anesthesia 1.
Key Considerations
- The epinephrine causes vasoconstriction, which reduces bleeding and slows lidocaine absorption, allowing for longer-lasting anesthesia and less systemic toxicity.
- The sodium bicarbonate helps reduce the burning sensation during injection by neutralizing the acidity of the lidocaine.
- This smaller volume of tumescent fluid is typically used for limited areas or touch-up procedures, as more extensive liposuction would require larger volumes of tumescent solution.
- The use of warm anesthetic solution and a slow infiltration rate is recommended to decrease patient discomfort during administration of tumescent local anesthesia 1.
Safety and Dosage
- The maximum safe dose of lidocaine with epinephrine for local tumescent anesthesia for liposuction is 55 mg/kg, as supported by studies on patients weighing 43.6-81.8 kg 1.
- For adults, no more than 7 mg/kg of lidocaine with epinephrine should be administered in a single treatment, as recommended for local infiltrative anesthesia 1.
- It's crucial to follow these guidelines to minimize the risk of toxicity and ensure patient safety during the procedure.
From the Research
Tumescent Fluid for Liposuction
- The recommended solution for tumescent liposuction typically consists of a dilute lidocaine solution with epinephrine, as described in 2.
- The maximal safe dosage of dilute lidocaine using the tumescent technique is estimated to be 35 mg/kg, as stated in 2.
- Studies have shown that lidocaine concentrations of 400-500 mg/L can provide adequate anesthesia for liposuction, as reported in 3 and 4.
Lidocaine Concentration and Volume
- A study found that a lidocaine concentration of 400 mg/L was effective for tumescent liposuction, with no statistically significant difference in pain levels compared to a concentration of 500 mg/L, as shown in 4.
- Another study suggested that a concentration of 500 mg/L may be required for some sensitive areas, as mentioned in 3.
- The volume of tumescent fluid used can vary, but a typical range is not specified for 250 mL, however, the actual volume of fluid in 1 L bags of saline can be more than the labeled amount, as noted in 5.
Safety Considerations
- Lidocaine toxicity is a potential complication of tumescent local anesthesia, and peak plasma levels of lidocaine can occur several hours after injection, as reported in 6.
- Doses of lidocaine up to 35 mg/kg were found to be sufficient for abdominal liposuction using the tumescent technique, but there is still a risk of subjective symptoms associated with peak lidocaine levels, as stated in 6.