Background: Lidocaine toxicity is a potential complication related to using tumescent local anesthesia (TLA) as the exclusive form of pain management in surgical procedures. Objective: We sought to determine the minimum concentration of lidocaine in the tumescent solution required to provide adequate anesthesia in patients undergoing liposuction using TLA exclusively. Methods: Liposuction using TLA exclusively was performed in 3430 procedures by the same surgeon. The initial concentration of 1000 mg/L lidocaine in the tumescent solution was gradually reduced to find the minimum required for adequate anesthesia. Results: Adequate anesthesia was achieved using a lidocaine concentration of 500 mg/L saline in all areas treated and 400 mg/L saline for most of the areas treated. Limitations: Data are based on the specific TLA technique used by the same surgeon. Lidocaine serum levels were not analyzed. Conclusion: For patients undergoing liposuction using TLA exclusively, the concentration of lidocaine in the normal saline solution required for adequate anesthesia is 400 mg/L for most body areas and 500 mg/L for some sensitive areas.

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American Academy of Dermatology. Journal
Erasmus MC: University Medical Center Rotterdam

Habbema, L. (2010). Efficacy of tumescent local anesthesia with variable lidocaine concentration in 3430 consecutive cases of liposuction. American Academy of Dermatology. Journal, 62(6), 988–994. doi:10.1016/j.jaad.2009.09.004