Tumescent Local Infiltration Anesthesia for Mini Abdominoplasty with Liposuction

Ahmed Abdalla Mohamed; Tamer Fayez Safan; Hamed Fathy Hamed; Maged Abdelwahab Abdelaziz Elgendy

doi:10.3889/oamjms.2018.475

Authors

Ahmed Abdalla Mohamed Faculty of Medicine, Cairo University, Cairo, Egypt
Tamer Fayez Safan Faculty of Medicine, Cairo University, Cairo, Egypt
Hamed Fathy Hamed Faculty of Medicine, Cairo University, Cairo, Egypt
Maged Abdelwahab Abdelaziz Elgendy Assistant Lecturer of anaesthesia, faculty of medicine, Cairo University

DOI:

https://doi.org/10.3889/oamjms.2018.475

Keywords:

Local anaesthesia, Mini Abdominoplasty, Liposuction, Pain scores, Satisfaction scoring

Abstract

AIM: To evaluate the feasibility and safety of mini abdominoplasty with liposuction under local tumescent anaesthesia (LA) as the sole anaesthetic modality.

METHODS: The study included 60 female patients with a mean age of 33.3 Â± 5.6 years. Local infiltration using a mixture of 1:1000 epinephrine (1 ml), 2% lidocaine (100 ml) and 0.5% Levobupivacaine (50 ml) in 2500 ml saline was started with Local infiltration started with the abdomen, outer thigh, hips, back, inner thighs and knees. After Mini Abdominoplasty with supplemental liposuction was conducted and application of suction drains wound closure was performed, and the tight bandage was applied. Pain during injection, incision and surgical manipulations was determined. Duration of postoperative analgesia, till oral intake and return home, patients and surgeon satisfaction scores were determined.

RESULTS: All surgeries were conducted completely without conversion to general anaesthesia. Injection pain was mild in 46 patients, moderate in 10 and hardly tolerated in 4 patients. Incision pain was mild in 16 patients, while 44 patients reported no sensation. During the surgical procedure, 6 patients required an additional dose of LA. Meantime till resumption of oral intake was 1.6 Â± 0.9 hours. Meantime till home return was 5.6 Â± 2.4 hours. Twelve patients were highly satisfied, 18 patients were satisfied, and these 42 patients were willing to repeat the trial if required. Eight patients found the trial is good and only one patient refused to repeat the trial and was dissatisfied, for a mean total satisfaction score of 3.1 Â± 0.9.

CONCLUSION: Mini Abdominoplasty with liposuction could be conducted safely under tumescent LA with mostly pain-free intraoperative and PO courses and allowed such surgical procedure to be managed as an office procedure. The applied anaesthetic procedure provided patientsâ€™ satisfaction with varying degrees in about 97% of studied patients.

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References

Bitar G, Mullis W, Jacobs W, et al. Safety and efficacy of office-based surgery with monitored anesthesia care/sedation in 4778 consecutive plastic surgery procedures. Plast Reconstr Surg. 2003; 111:150â€“6. https://doi.org/10.1097/00006534-200301000-00025 PMid:12496575

Agbakwuru EA, Salako AA, Olajide AO, Takure AO, Eziyi AK: Hydrocelectomy under local anaesthesia in a Nigerian adult population. Afr Health Sci. 2008; 8(3):160-2. PMid:19357743 PMCid:PMC2583265

Parirokh M, Satvati SA, Sharifi R, Rekabi AR, Gorjestani H, Nakhaee N, Abbott PV: Efficacy of combining a buccal infiltration with an inferior alveolar nerve block for mandibular molars with irreversible pulpitis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2010; 109(3):468-73. https://doi.org/10.1016/j.tripleo.2009.11.016 PMid:20219602

Gun R, YorgancÄ±lar E, YÄ±ldÄ±rÄ±m M, BakÄ±r S, Topcu I, Akkus Z: Effects of lidocaine and adrenaline combination on postoperative edema and ecchymosis in rhinoplasty. Int J Oral Maxillofac Surg. 2011; 40(7):722-9. https://doi.org/10.1016/j.ijom.2011.02.022 PMid:21458231

Chia CT, Theodorou SJ: 1,000 consecutive cases of laser-assisted liposuction and suction-assisted lipectomy managed with local anesthesia. Aesthetic Plast Surg. 2012; 36(4):795-802. https://doi.org/10.1007/s00266-012-9885-2 PMid:22447150

Tahiri Y, Tran de QH, Bouteaud J, et al. General anaesthesia versus thoracic paravertebral block for breast surgery: a meta-analysis. J Plast Reconstr Aesthet Surg. 2011; 64:1261â€“1269. https://doi.org/10.1016/j.bjps.2011.03.025 PMid:21486711

Kashiwagi S, Asano Y, Watanabe M, Takii M, Morisaki T, Aomatsu N, Nakamura M, Kawajiri H, Takashima T, Onoda N, Ishikawa T, Wakasa K, Hirakawa K: Day surgery of early breast cancer treated with breast-conserving operation following sentinel lymph node navigation biopsy under local anesthesia. Gan To Kagaku Ryoho. 2012; 39(12):1914-6. PMid:23267928

Bray GA: Pathophysiology of obesity. Am J Clin Nutr, 1992; 55:488S-94S. https://doi.org/10.1093/ajcn/55.2.488s PMid:1733117

Vella M, Galloway DJ: Laparoscopic adjustable gastric banding for severe obesity. Obes Surg. 2003; 13(4):642-8. https://doi.org/10.1381/096089203322190899 PMid:12935369

Carlson GW: Total mastectomy under local anesthesia: the tumescent technique. Breast J. 2005; 11(2):100-2. https://doi.org/10.1111/j.1075-122X.2005.21536.x PMid:15730454

Sleth JC, Servais R, Saizy C: Tumescent infiltrative anaesthesia for mastectomy: about six cases. Ann Fr Anesth Reanim. 2008; 27(11):941-4. https://doi.org/10.1016/j.annfar.2008.08.011 PMid:19004607

Ranieri E, Larcinese A, Barberi S, Caprio G, Naticchioni E, Civitelli L, Paglicci C, Pagni P, Zancla S, Rengo M, Di Giorgio A: Quadrantectomy and removal of the sentinel lymph node under local anaesthesia in the day hospital setting. Chir Ital. 2008; 60(3):391-4. PMid:18709777

Groetelaers RP, van Berlo CL, Nijhuis PH, Schapers RF, Gerritsen HA: Axillary recurrences after negative sentinel lymph node biopsy under local anaesthesia for breast cancer: a follow-up study after 5 years. Eur J Surg Oncol. 2009; 35(2):159-63. https://doi.org/10.1016/j.ejso.2008.07.017 PMid:18789841

Habbema L: Breast reduction using liposuction with tumescent local anesthesia and powered cannulas. Dermatol Surg. 2009; 35(1):41-50. PMid:19076201

Habbema L, Alons JJ: Liposuction of the female breast: a histologic study of the aspirate. Dermatol Surg. 2010; 36(9):1406-11. https://doi.org/10.1111/j.1524-4725.2010.01649.x PMid:20629687

Kitowski NJ, Landercasper J, Gundrum JD, De Maiffe BM, Chestnut DH, Bottcher ML, Johnson JM, Johnson RL: Local and paravertebral block anesthesia for outpatient elective breast cancer surgery. Arch Surg. 2010; 145(6):592-4. https://doi.org/10.1001/archsurg.2010.77 PMid:20566982

Kashiwagi S, Takashima T, Asano Y, Morisaki T, Aomatsu N, Matsuoka J, Nakamura M, Kawajiri H, Onoda N, Ishikawa T, Hirakawa K: Lumpectomy and sentinel lymph node navigation surgery for breast cancer under local anesthesia. Gan To Kagaku Ryoho. 2011; 38(12):2017-9. PMid:22202270

Hardwicke JT, Jordan RW, Skillman JM: Infiltration of epinephrine in reduction mammaplasty: a systematic review of the literature. Plast Reconstr Surg. 2012; 130(4):773-8. https://doi.org/10.1097/PRS.0b013e318262f085 PMid:23018690

ManfÃ¨ AZ, Marchesini M, Bortolato A, Feltracco P, Lumachi F: Ropivacaine versus levobupivacaine for minor breast surgery in outpatients: inversion of postoperative pain relief efficacy. In Vivo. 2012; 26(6):1075-7. PMid:23160696

Klein JA. Tumescent technique for local anesthesia improves safety in large-volume liposuction. Plast Reconstr Surg. 1993; 92:1085â€“98. https://doi.org/10.1097/00006534-199311000-00014 PMid:8234507

Kendler M, Micheluzzi M, Wetzig T, Simon JC. Electrochemotherapy under tumescent local anesthesia for treatment of cutaneous metastases. Dermatolog Surg. 2013; 39:1023â€“32. https://doi.org/10.1111/dsu.12190 PMid:23464631

Coldiron B, Coleman WP III, Cox SE, Jacob C, Lawrence N, Kaminer M, Narins RS. ASDS guidelines of care for tumescent liposuction. Dermatol Surg. 2006; 32:709â€“16. https://doi.org/10.1111/j.1524-4725.2006.32159.x PMid:16706767