9902-666 Craig
Craig SB, Concannon MJ, McDonald GA, Puckett CL.
The antibacterial effects of tumescent liposuction fluid.
Plast Reconstr Surg. 1999 Feb;103(2):666-70. PMID: 9950558
Comment in:
Plast Reconstr Surg. 1999 Nov;104(6):1934.
Division of Plastic Surgery, University of Missouri, Columbia 65212, USA.
Tumescent liposuction is currently one of the most commonly performed aesthetic
procedures. Despite the variable use of preoperative antibiotics, infection is
uncommon. Prior works suggest that the low incidence of infection may be due to
lidocaine's antibacterial properties. However, these properties have only been
demonstrated using concentrations of lidocaine above 0.8%, significantly higher
than those used in tumescent liposuction. The purpose of this study was to
determine if the commonly used tumescent fluid containing 0.1% lidocaine,
1:1000,000 epinephrine, and 0.012 mEq sodium bicarbonate possesses antibacterial
activity. Using the broth microdilution method, the minimum inhibitory
concentrations of Escherichia coli, Proteus mirabilis, Pseudomonas aeruginosa,
Staphylococcus aureus, and Group A beta-hemolytic Streptococcus were determined
after exposure to either lidocaine, epinephrine, bicarbonate, or the combination
of all three agents. To determine if there were significant growth differences
not detectable by the broth microdilution method, bacterial concentrations were
obtained through the use of a spectrophotometer, and significant differences
from the controls were calculated by one-way analysis of variance. To determine
if prolonged exposure to the tumescent mix would alter bacterial growth, a
Killing Time study was also undertaken. The results indicated that the minimum
inhibitory concentration of lidocaine was not less than 0.5% for any of the
bacteria, whereas the lowest minimum inhibitory concentration of the combined
solution was 0.25%. The lowest inhibitory concentration as determined by
spectrophotometric analysis for the combined solution was 0.13% (p < 0.01).
Analysis of the Killing Time data revealed no inhibition of bacterial growth
over time. In conclusion, lidocaine, epinephrine, and bicarbonate do exhibit
antibacterial properties at high concentrations. However, the commonly used
tumescent mixture containing dilute concentrations of these agents does not
significantly inhibit the growth of commonly encountered bacteria.
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