Tumescent Liposuction

The evolution of liposuction has been multidisciplinary. The tumescent variant was developed using dilute local lidocaine and epinephrine and was meant to specifically exclude additional intravenous sedation, regional or general anesthesia, and intravenous fluids. Clinical pharmacology, pathophysiology, and safety studies are reviewed in this article. Tumescent formulations for varied anatomic sites are discussed, as well as other indications for tumescent anesthesia.

Key points

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It is no longer true tumescent liposuction if general anesthetic, sedatives/dissociative agents (propofol, ketamine, etomidate, midazolam), or analgesics that result in moderate or deep sedation (fentanyl, morphine, ketamine) are used.
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Pharmacovigilance is mandatory given that concurrent cytochrome P450 metabolic substrates can affect lidocaine metabolism.
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Infection rates associated with true tumescent liposuction have been rare, estimated at less than 1 per 2000 cases, and have been attributed to the antibacterial activity of lidocaine.
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There is significantly less potential for morbidity and mortality when general anesthetic and moderate or deep sedation during liposuction are avoided (consistent with criteria for true tumescent liposuction).
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For liposuction, it is not necessary to use local anesthetics, which are longer acting and potentially more cardiotoxic than lidocaine.
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Given that there is no anesthetist present in true tumescent liposuction, advanced cardiac life support certification for surgeon and assisting nursing staff is mandatory.