Efficacy of tumescent local anesthesia with variable lidocaine concentration in 3430 consecutive cases of liposuction

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. (J Am Acad Dermatol 2010;62:988-94.)