9903-990 Rubin
Rubin JP, Bierman C, Rosow CE, Arthur GR, Chang Y, Courtiss EH, May JW Jr.
The tumescent technique: the effect of high tissue pressure and dilute
epinephrine on absorption of lidocaine.
Plast Reconstr Surg. 1999 Mar;103(3):990-6; discussion 997-1002. PMID: 10077095
Department of Surgery, Massachusetts General Hospital, Boston 02114, USA.
Injection of lidocaine into the subcutaneous tissues by the tumescent technique
results in a delayed absorption of the local anesthetic and has allowed
clinicians to exceed the maximum recommended dose of lidocaine without reported
complications. However, little knowledge exists about the mechanisms that permit
such high doses of lidocaine to be used safely with this technique. The presence
of low concentration epinephrine and the increased tissue pressure resulting
from the tumescent injection have both been implicated as important factors, but
neither has been studied in patients whose results were not altered by the
variability of the suction procedure. The purpose of this work was to determine
the effect of tissue pressure during tumescent injection and presence of low
concentration epinephrine on the absorption of lidocaine from subcutaneous
tissues in human volunteers. Twenty healthy female human volunteers were
randomized into four study groups. After body fat measurements, all subjects
received an injection of 7 mg/kg of lidocaine into the subcutaneous tissues of
both lateral thighs. The injected solution consisted of 0.1% lidocaine and 12.5
meq/liter sodium bicarbonate in normal saline with or without 1:1,000,000
epinephrine. Tissue pressure was recorded during injection using a specially
designed double-barreled needle. The time required for injection was also
recorded. Subjects in group 1 received lidocaine with epinephrine injected by a
high-pressure technique. Group 2 subjects received lidocaine with epinephrine
injected by a low-pressure technique. Group 3 subjects received lidocaine
without epinephrine injected under high pressure. Group 4 subjects received
lidocaine without epinephrine injected under low pressure. Following injection,
sequential blood samples were drawn over a 14-hour period, and plasma lidocaine
concentrations were determined by gas chromatography. No suction lipectomy was
performed. Maximum tissue pressure during injection was 339 +/- 63 mmHg and 27
+/- 9 mmHg using high- and low-pressure techniques, respectively. Addition of
1:1,000,000 epinephrine, regardless of the pressure of injected fluid,
significantly delayed the time to peak plasma concentration by over 7 hours.
There was no significant difference in the peak plasma concentration of
lidocaine among the four groups. Peak plasma concentrations greater than 1
mcg/ml were seen in 11 subjects. Epinephrine (1:1,000,000) significantly delays
the absorption of lidocaine administered by the tumescent technique. High
pressure generated in the subcutaneous tissues during injection of the solution
does not affect lidocaine absorption. The delay in absorption may allow time for
some lidocaine to be removed from the tissues by suction lipectomy. In addition,
the slow rise to peak lidocaine concentration in the epinephrine groups may
allow the development of systemic tolerance to high lidocaine plasma levels.
Publication Types:
Clinical Trial
Randomized Controlled Trial
|
