Tumescent Technique in Aesthetic Plastic Surgery with Low Doses of Prilocaine Solution,Part I

Abstract

Introduction:

In Germany the local anesthetic prilocaine has gained popularity for use in tumescent solutions. However, although prilocaine shows the lowest toxicity of the local anesthetics, the use of prilocaine in higher doses leads to methemoglobinemia. We report a clinical study that determines whether adequate local anesthesia can be achieved with low concentrations of prilocaine (less than 0.05%).

Materials and Methods:

Twelve patients from anesthesia risk groups ASA I and II participated in the study. The patients were medicated with 25 mg piritramide orally and with 1000 mg acetaminophen by suppository. By means of an infusion system and a pump syringe, tumescent solution was injected into the subcutis until the tissue was completely infiltrated. This initial injection used approximately two thirds of the total quantity of solution, and the remaining tumescent solution was injected roughly 30 minutes later, resulting in ultratumescence.

A 0.038% solution of prilocaine was used. Two 3-L bags with additives were instilled as the standard for treatment. The total injection volume was 6.3 L. A total of 2400 mg of prilocaine was administered, which is 4 times higher than the recommended maximum dose for infiltration anesthesia using prilocaine with epinephrine. The subjective tolerability of the tumescent local anesthesia was measured by interview and documentation.

Results:

In all cases, it was possible to perform the liposuction using prilocaine in a concentration of 0.038%. Eight of the 12 patients needed supplemental intravenous doses of 3.75–11.25 mg of piritramide. Discomfort was reported by 3 patients during the infiltration and by 6 patients during liposuction. Two patients received analgesic during the infiltration, and 8 patients received analgesic during liposuction. All patients were ambulatory immediately following surgery. All patients were satisfied with the tumescent local anesthesia and would agree to using it again in liposuction.

Discussion:

The low concentration of prilocaine used in the tumescent solution (0.038%) proved sufficient for liposuction. The more dilute solution allows for a greater volume of the tumescent solution to be used without causing more side effects. The increased procedure time of up to 6 hours seems justified by the safety and efficacy of the technique.