Tumescent anesthesia
DefinitionThis section has been translated automatically.
Regional anaesthesia of the skin and subcutaneous fatty tissue known since about 1987 by application of large quantities of a local anaesthetic diluted about 100 times. In this way large areas of the body can be operated on under local anaesthetic, which previously could only be treated under general anaesthetic.
General definitionThis section has been translated automatically.
Physiological saline solution or Ringer's solution are generally used as carrier substance. The most important effect of the carrier solution is the swelling of the tissue. The local anaesthetic consists of prilocaine (preferably) ropivacaine or lidocaine. Bicarbonate can be used as an additive to the tumescent solution to achieve an increase in tissue pH. This results in a better penetration of the substances into the tissue.
ImplementationThis section has been translated automatically.
Infiltration of large volumes (2.0 to max. 6.0 l) of a diluted local anaesthetic (see table). The application time until safe anaesthesia should not be less than one hour.
Undesirable effectsThis section has been translated automatically.
Cave! Increase in meth-HB. Regular monitoring of O2 saturation and Meth-HB is recommended. Prophylactically, the intravenous administration of vitamin C is recommended. In case of a rapid increase of Meth-HB, slow intravenous administration of methylene blue (1-2 mg/kg bw i.v.), if necessary repeat after 4-6 hours.
Complication(s)This section has been translated automatically.
Complications occur in about 1.5% of cases. The large amount of local anaesthetic can lead to severe cardiovascular problems and cardiac arrhythmia.
LiteratureThis section has been translated automatically.
- Acosta AE (1997) Clinical parameters of tumescent anesthesia in skin cancer reconstructive surgery. A review of 86 patients. Arch Dermatol 133: 451-454
- Breuninger H (2009) History of tumenescence anaesthesia. Act Dermatol 35: 290-292
- Grassegger A, Haussler R et al (2001) Is the use of tumescence anesthesia in general anesthesia contraindicated? Anaesthesiologist 50: 363-364
- Hempel V (2001) Is the use of tumescence anesthesia in general anesthesia contraindicated? Anesthesiologist 50: 363-364
- small YES (1987) The tumenescent technique for liposuction surgery. At J Cosmet Surgery 4: 263-267
- Selzle KET al. (2001) Tumescence local anesthesia in venous surgery. Central bl surgery 126: 517-521
- Weinberg GL et al (1997) Malignant ventricular dysrhythmias in a patient with isovaleric academia receiving general and local anesthesia for suction lipectomy. J Clin Anesth 9: 668-670
TablesThis section has been translated automatically.
Tumescence solution according to Sattler
Active ingredient* |
Quantity* |
Prilocaine (lidocaine is used in the Klein solution) |
500 mg |
Epinephrine |
1 mg |
Sodium hydrogen carbonate |
500 mg |
Sodium chloride |
9,000 mg |
* The listed quantities/active ingredients refer to 1 l solution each according to Sattler | |
Advantages |
Disadvantages |
Excellent analgesia of large areas |
Tumescent fluid in the Op-Area |
Low blood loss |
Considerable time required for analgesia |
Persistent postoperative analgesia |
Clear stress situation for patient and surgeon |
Early Mobilization |
Necessary patient guidance during the operation |
Low preoperative diagnostics (blood count, coagulation, possibly ECG) |
Moisture in the dressings due to escaping anaesthetic fluid |