Tumescent Anesthesia With a Lidocaine Dose of 55 mg/kg is Safe For Liposuction
Dermatologic Surgery
1996 Abstract
9611-921 Ostad
Ostad A, Kageyama N, Moy RL.
Tumescent anesthesia with a lidocaine dose of 55 mg/kg is safe for liposuction. Dermatol Surg. 1996 Nov;22(11):921-7. PMID: 9063507
Department of Dermatology, New York University School of Medicine, New York,
USA.
BACKGROUND: The safe upper limit of lidocaine dosage in tumescent anesthesia for
liposuction has been reported to be 35 mg/kg. OBJECTIVE: This study was
undertaken to: 1) evaluate the safety of tumescent anesthesia in liposuction
when lidocaine doses greater than 35 mg/kg are required, 2) determine the time
interval when the peak plasma lidocaine level occurs following administration of
tumescent anesthesia, and 3) assess if the safety of large volume tumescent
anesthesia is due to significant lidocaine removed by liposuction. METHODS:
Sixty patients who underwent liposuction with a mean lidocaine dose of 57 mg/kg
were prospectively evaluated for development of any signs or symptoms of
lidocaine toxicity by multiple interviews over a 24-hour period. In addition,
another 10 patients who received a mean lidocaine dose of 55 mg/kg had serial
plasma lidocaine level measurements over a 24-hour period following liposuction.
The lidocaine level of the aspirate was also measured to assess any significant
lidocaine removed by liposuction. RESULTS: No evidence of lidocaine toxicity was
found based on subjective evaluation of 60 patients as well as determined by
plasma sampling of 10 patients. The peak plasma lidocaine concentration occurred
at approximately 4 or 8 hours after infusion of tumescent anesthesia. The
24-hour plasma lidocaine level suggests that residual lidocaine is present in
the subcutaneous tissue allowing for postoperative analgesia beyond this time. A
negligible amount of lidocaine was removed by liposuction as determined by the
lidocaine level of the aspirate. CONCLUSION: This study suggests that tumescent
anesthesia with a total lidocaine dose of up to 55 mg/kg is safe for use in
liposuction.