Tumescent Anesthesia for Liposuction
The recent proliferation of liposuction technology offers patients and surgeons a bewildering range of options, including standard suction, laser lipolysis, ultrasound, and power-assisted liposuction, among others.
However, the innovation that probably had the greatest effect in popularizing liposuction occurred in 1987.
This was the development of tumescent anesthesia.
Prior to 1987, the infiltration of fluid containing saline, lidocaine and epinephrine varied from none to the "wet" or "super-wet" technique.
These anesthesia techniques were associated with a higher frequency of hematoma and seroma formation, greater bruising, and a higher frequency of blood transfusions.
Due to the prevalence of side-effects, such procedures were almost always performed in hospital operating rooms.
In 1987, Jeff Klein revolutionized liposuction when he described the tumescent technique.
This local anesthetic technique involved infiltrating relatively large amounts of saline with very dilute lidocaine and epinephrine.
"Tumescent" refers to the swollen and doughy appearance of the skin and fat after the fluid is infused.
Klein demonstrated that excellent anesthesia could be achieved despite a very low-concentration of lidocaine, contradicting existing dogma.
He also showed that much higher total doses of lidocaine could safely be used when in this lower concentration.
The epinephrine in dilute form greatly reduced blood loss, bruising and hematoma/seroma formation.
Finally the "tumesced" fatty tissue could more easily and precisely be suctioned away than fat that was not infiltrated.
The safety of tumescent anesthesia allowed surgeons to offer liposuction to their patients outside of the constraints of the operating room and general anesthesia.
Liposuction procedures came to be frequently performed in office-based procedure rooms.
Research has have shown that complication rates are lower in liposuction procedures performed in the office than in ambulatory surgery centers or hospitals.
Complication rates are also lower when using oral-only or no sedation, compared to intravenous or intramuscular sedation.
One may speculate on the possible reasons for this, but preservation of airway reflexes and the feedback during the procedure from awake patients probably make such procedures safer.
Tumescent anesthesia requires rigorous and meticulous adherence to published formulas to be safe.
The patient's weight, relative body fat, and the number of areas being treated are important considerations and determine the calculations.
It is recommended that the operating surgeon directly supervise or personally mix the anesthetic fluid to ensure that it is made correctly.
If the total amount of fat or number of areas exceeds accepted limits, then the procedure can be broken down into two.
Regardless of the type of cannula used or adjunctive technology, such as laser or vibration, tumescent liposuction technique is nearly universal.
It is hoped that future research will provide further refinements and clarifications.
However, the innovation that probably had the greatest effect in popularizing liposuction occurred in 1987.
This was the development of tumescent anesthesia.
Prior to 1987, the infiltration of fluid containing saline, lidocaine and epinephrine varied from none to the "wet" or "super-wet" technique.
These anesthesia techniques were associated with a higher frequency of hematoma and seroma formation, greater bruising, and a higher frequency of blood transfusions.
Due to the prevalence of side-effects, such procedures were almost always performed in hospital operating rooms.
In 1987, Jeff Klein revolutionized liposuction when he described the tumescent technique.
This local anesthetic technique involved infiltrating relatively large amounts of saline with very dilute lidocaine and epinephrine.
"Tumescent" refers to the swollen and doughy appearance of the skin and fat after the fluid is infused.
Klein demonstrated that excellent anesthesia could be achieved despite a very low-concentration of lidocaine, contradicting existing dogma.
He also showed that much higher total doses of lidocaine could safely be used when in this lower concentration.
The epinephrine in dilute form greatly reduced blood loss, bruising and hematoma/seroma formation.
Finally the "tumesced" fatty tissue could more easily and precisely be suctioned away than fat that was not infiltrated.
The safety of tumescent anesthesia allowed surgeons to offer liposuction to their patients outside of the constraints of the operating room and general anesthesia.
Liposuction procedures came to be frequently performed in office-based procedure rooms.
Research has have shown that complication rates are lower in liposuction procedures performed in the office than in ambulatory surgery centers or hospitals.
Complication rates are also lower when using oral-only or no sedation, compared to intravenous or intramuscular sedation.
One may speculate on the possible reasons for this, but preservation of airway reflexes and the feedback during the procedure from awake patients probably make such procedures safer.
Tumescent anesthesia requires rigorous and meticulous adherence to published formulas to be safe.
The patient's weight, relative body fat, and the number of areas being treated are important considerations and determine the calculations.
It is recommended that the operating surgeon directly supervise or personally mix the anesthetic fluid to ensure that it is made correctly.
If the total amount of fat or number of areas exceeds accepted limits, then the procedure can be broken down into two.
Regardless of the type of cannula used or adjunctive technology, such as laser or vibration, tumescent liposuction technique is nearly universal.
It is hoped that future research will provide further refinements and clarifications.