9405-1217 Samdal
Samdal F, Amland PF, Bugge JF.
Plasma lidocaine levels during suction-assisted lipectomy using large doses of
dilute lidocaine with epinephrine.
Plast Reconstr Surg. 1994 May;93(6):1217-23. PMID: 8171141
Department of Plastic Surgery, Norwegian National Hospital, Oslo.
Liposuction, like many other plastic surgical procedures, is often performed
under local anesthesia. Drug toxicity is the most serious complication and the
factor that limits the use of this form of anesthesia. Toxic effects are related
to the peak concentration in plasma and depend on the type of local anesthetic,
the drug concentration, total dose, site of injection, injection speed, and
whether vasoconstrictors are used or not. This study evaluates the use of large
volumes of subcutaneously injected 0.1% lidocaine with epinephrine 1:1,000,000
as the local anesthetic procedure in 12 patients undergoing suction-assisted
lipectomy of the abdomen, flanks, and/or lower extremities. A total dose of 1260
to 2880 mg lidocaine corresponding to 10.5 to 34.4 mg/kg was administered with
an injection speed of 60 to 78 ml/min. The peak concentration of lidocaine
varied between 0.9 and 3.6 micrograms/ml and occurred between 6 and 12 hours
postoperatively. For the given dose range, a linear correlation (r = 0.83) was
found between the total dose of lidocaine and the peak concentration in plasma.
A dose increase of 1 mg/kg raised the peak concentration approximately 0.1
microgram/ml. Our data clearly demonstrate that when using pH-adjusted 0.1%
lidocaine with epinephrine subcutaneously for suction-assisted lipectomy,
lidocaine can be administrated safely in significantly higher doses than
recommended. When such high doses are used, the patient probably should be
observed for at least 18 hours postoperatively.
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