Tumescent Anesthesia Protocol

Anesthetic Agent Selection

The American Academy of Dermatology recommends lidocaine with epinephrine as the primary agent for tumescent anesthesia in liposuction, with Level I and II evidence supporting its use 1
The addition of epinephrine to lidocaine is both safe and recommended, providing vasoconstriction that reduces blood loss and slows systemic absorption 1
Prilocaine is safe and effective for tumescent anesthesia, though not FDA-approved for this indication in the United States, and may be used in combination with lidocaine to reduce toxicity risk when large volumes are needed 1, 2
Bupivacaine has no data supporting its use in tumescent anesthesia and cannot be recommended 1, 2

The maximum dose of lidocaine with epinephrine for liposuction procedures is 55 mg/kg, validated only for patients weighing 43.6-81.8 kg 1
For non-liposuction dermatologic procedures, the maximum dose of lidocaine with epinephrine should not exceed 7.0 mg/kg for adults 3, 4
For children, the maximum dose of lidocaine with epinephrine is 3.0-4.5 mg/kg 3, 4

The solution should be warmed to 40°C before administration, which significantly reduces discomfort (Level II evidence) 1, 2
The solution should be administered at a slow infiltration rate, which reduces patient discomfort during administration 1, 2
Aspirate before each injection to avoid intravascular administration 3, 4
Use incremental injections 3, 4

Use the lowest effective dose to prevent local anesthetic systemic toxicity (LAST) 3, 4
Aspirate needle/catheter before each injection to prevent LAST 3, 4
Continuously monitor and communicate with the patient for early toxicity signs 3, 4