From the Guidelines
A recommended solution for 60 mL of tumescent fluid for liposuction is a mixture containing 50 mL of normal saline (0.9% NaCl), 10 mL of 1% lidocaine (100 mg), and 1 mL of epinephrine (1:1000 concentration). This small volume is appropriate for very limited procedures or touch-ups. For the solution to be effective, ensure the lidocaine concentration remains at approximately 0.1% (1 mg/mL) for adequate local anesthesia, as supported by the guidelines for the use of local anesthesia in office-based dermatologic surgery 1. The epinephrine causes vasoconstriction, which reduces bleeding, prolongs the anesthetic effect, and helps with tissue dissection.
Key Considerations
- The solution should be prepared under sterile conditions immediately before use.
- For larger areas, proportionally larger volumes would be needed - typically 250-500 mL per treatment area.
- The pH of the solution can be buffered with 1 mEq of sodium bicarbonate per 10 mL of lidocaine to reduce injection discomfort, as suggested by the guidelines 1.
- Always respect the maximum safe dose of lidocaine (55 mg/kg with epinephrine for tumescent local anesthesia) to prevent toxicity, as recommended by the guidelines 1.
- Allow 20-30 minutes after injection before beginning liposuction to achieve optimal tissue tumescence and anesthetic effect.
Safety and Efficacy
The use of lidocaine and epinephrine in tumescent local anesthesia for liposuction has been shown to be safe and effective, with a maximum dose of 55 mg/kg of lidocaine with epinephrine recommended for patients weighing 43.6-81.8 kg 1. The addition of epinephrine to lidocaine is recommended and safe for use in tumescent local anesthesia for liposuction, and the use of warm anesthetic solution and a slow infiltration rate is recommended to decrease patient discomfort during administration of tumescent local anesthesia 1.
From the Research
Tumescent Fluid for Liposuction
- The recommended solution for tumescent anesthesia typically consists of a dilute mixture of lidocaine and epinephrine in a saline solution 2, 3, 4.
- The maximum safe dose of lidocaine with epinephrine in tumescent anesthesia for liposuction is probably between 35 and 55 mg/kg 5, 4.
- For 60 milliliters (mL) of tumescent fluid, the concentration of lidocaine is typically around 0.05% to 0.1% 2, 3.
- However, the actual amount of lidocaine contained within the stock solution may vary, with an average of 54 ml of anesthetic in a 50 ml bottle 2.
- The use of tumescent anesthesia allows for the removal of large volumes of fat with minimal blood loss, and peak plasma lidocaine levels typically occur 12 hours after the initial injection 3, 5.
Considerations for Tumescent Anesthesia
- Dermatologic surgeons should be aware of the extra fluid possibly contained within tumescent anesthetic preparation and the potential for decreased concentration of lidocaine within the final tumescent anesthesia 2.
- The slow infiltration of a local anesthetic solution minimizes the rate of systemic absorption and reduces the potential for toxicity 3, 4.
- Patients should be monitored during the procedure and for a sufficient period of time thereafter by adequately trained staff, especially those with cardiac or pulmonary risk factors 6, 4.