Tumescent solution and liposuction safety

What is tumescent anesthesia?

Before liposuction, a large volume of fluid is injected into the fat layer. This is called tumescent solution. A 2013 review described tumescent anesthesia as a method in which a very dilute local anesthetic mixed with epinephrine and sodium bicarbonate is injected until the tissue becomes firm and taut ^[1].

Tumescent liposuction was developed using dilute lidocaine and epinephrine, and it was originally designed to be performed without additional intravenous sedation, regional or general anesthesia, or intravenous fluids ^[2]. It was first introduced in the field of liposuction, but its use has since expanded to vascular surgery, breast surgery, plastic surgery, and ear, nose, and throat surgery ^[1].

The local anesthesia placed around the veins in vein surgery (perivenous anesthesia) also developed from tumescent anesthesia, and the literature explains that its safety increases when skilled ultrasound guidance and careful attention from the practitioner are added ^[6].

What does the tumescent solution do?

The epinephrine in the solution narrows blood vessels, and the large volume of fluid adds a pressure effect by compressing the tissue, which reduces bleeding ^[1]. Sodium bicarbonate reduces the pain of injecting local anesthetic, which is acidic ^[1].

Lidocaine injected into the tissue under the skin is absorbed very slowly, so its blood levels are lower and peak later than when it is given by other routes, and its pain-relieving effect after surgery lasts longer ^[1]. The literature notes that because the liver processes lidocaine quickly while it is being slowly absorbed, blood levels can stay within a safe range ^[1].

Because of these properties, it has been reported that much larger amounts of lidocaine per unit of body weight can be used in tumescent liposuction than in typical local anesthesia ^{[1, 4]}. However, it has been pointed out that opinions on the maximum allowable dose differ considerably between specialties ^[4]. The amount to be used is calculated by the medical team based on the patient's weight and condition, and a 2017 evidence-based review also presented accurately calculating each patient's lidocaine limit for safe administration as a key learning objective ^[5].

Differences by type of anesthesia

A 2010 review explained that tumescent liposuction, a local anesthesia technique, and superwet liposuction, which is used together with systemic (whole-body) anesthesia, are the most common methods ^[3]. Both methods were rated as having an excellent safety record, but the review considered that local anesthesia can avoid the risks specific to general anesthesia ^[3].

The same review summarized that liposuction effectively refines the contours of the trunk, arms and legs, and the area under the chin in appropriately selected patients, and stated that no new technology appears to produce results superior to those of established methods ^[3].

A 2017 review explained that liposuction, introduced in the 1980s, has become the most commonly performed cosmetic procedure in the world, and that as experience has accumulated, safety, patient selection, assessment before surgery, fluid management, proper technique, and overall patient care have been emphasized and improved ^[5].

What is checked for safety

A 2017 review stressed identifying, before surgery, warning signs in the medical history and examination that may indicate a higher risk with liposuction, and it also covered the prevention of deep venous thromboembolism (blood clots in the deep veins) and both common and rare complications ^[5].

A 2013 review stressed that the dose of local anesthetic must be carefully adjusted when a person is taking medications that affect how the liver processes drugs, or has a condition that reduces blood flow to the liver ^[1]. It considered that following these pharmacological principles is why this method has shown an exemplary safety record to date ^[1]. It is therefore important to tell your medical team about all the medications you take and any conditions you have before surgery.

A 2020 review considered that tumescent anesthesia is generally well tolerated by patients and relatively safe within recommended doses ^[4]. However, it stressed that the signs and symptoms of local anesthetic systemic toxicity may not appear until several hours after the procedure, so vigilance must not be relaxed, and that lipid emulsion therapy should be kept ready for immediate use in case it is needed ^[4].

Complications and recovery

A 2010 review named uneven contours and temporary bruising as the most common complications of liposuction ^[3]. After surgery, swelling and bruising often appear and then subside over time, but the speed of recovery and the final contour vary from person to person depending on skin elasticity and the extent of liposuction.

It is also important to remember that symptoms related to the anesthetic may appear late, during the first several hours after surgery ^[4]. If you notice anything unusual, such as dizziness, numbness around the mouth, ringing in the ears, or a pounding heartbeat, tell the medical team right away.

What to check during your consultation

The tumescent solution is directly related to the safety of liposuction and to your recovery. It is a good idea to check the following during your examination and consultation.

• The anesthesia method (local anesthesia, sedation, or general anesthesia) and why it was chosen
• Medications you currently take and underlying conditions such as liver disease
• How large an area will be treated at one time and how long the surgery will take
• Safety measures before and after surgery, including prevention of blood clots
• How to contact the clinic if you have unusual symptoms after surgery