The tumescent technique: the effect of high tissue pressure and dilute epinephrine on absorption of lidocaine.

摘要: Injection of lidocaine into the subcutaneous tissues by tumescent technique results in a delayed absorption local anesthetic and has allowed clinicians to exceed maximum recommended dose without reported complications. However, little knowledge exists about mechanisms that permit such high doses be used safely with this technique. The presence low concentration epinephrine increased tissue pressure resulting from injection have both been implicated as important factors, but neither studied patients whose were not altered variability suction procedure. purpose work was determine effect during on human volunteers. Twenty healthy female volunteers randomized four study groups. After body fat measurements, all subjects received an 7 mg/kg lateral thighs. injected solution consisted 0.1% 12.5 meq/liter sodium bicarbonate normal saline or 1:1,000,000 epinephrine. Tissue recorded using specially designed double-barreled needle. time required for also recorded. Subjects group 1 high-pressure Group 2 low-pressure 3 under pressure. 4 Following injection, sequential blood samples drawn over 14-hour period, plasma concentrations determined gas chromatography. No lipectomy performed. Maximum 339 +/- 63 mmHg 27 9 high- techniques, respectively. Addition epinephrine, regardless fluid, significantly peak hours. There no significant difference among Peak greater than mcg/ml seen 11 subjects. Epinephrine (1:1,000,000) delays administered High generated does affect absorption. delay may allow some removed lipectomy. In addition, slow rise groups development systemic tolerance levels.