Tumescent anesthesia (synonym: tumescent local anesthesia (TLA)) is one of the local anesthesia procedures, along with surface anesthesia, infiltration anesthesia, and regional anesthesia. It is a form of infiltration anesthesia and is used for cosmetic surgery procedures, such as liposuction. In 1987, liposuction using tumescent local anesthesia (TLA)was performed for the first time by the American dermatologist (dermatologist) Jeffrey Klein. For this purpose, a large volume of fluid mixed with a local anesthetic is injected into the subcutaneous fat tissue, which facilitates the actual liposuction. Because liposuction is a major surgical procedure, general anesthesia is usually also administered. The uncritical use of tumescent anesthesia is controversial because of the sometimes significant side effects.
Indications (areas of application)
- Cosmetic surgery procedures – liposuctions (liposuction).
Contraindications
- Pre-existing cardiac conditions – heart failure (cardiac insufficiency), valvular defects or cardiac arrhythmias may decompensate (acute worsening of condition) under volume loading.
- Pheochromocytoma – tumor of the so-called chromaffin cells of the adrenal gland. This can produce catecholamines (hormones that include epinephrine), which systemically lead to characteristic symptoms.
Before surgery
Before surgery, the patient should be thoroughly informed about both the risks of tumescent anesthesia and the dangers of cosmetic surgery. Cardiovascular disease (heart and vascular disease) and allergies to the local anesthetic must be ruled out by taking a medical history.
The procedure
The liposuction procedure is not part of this article (for more information, see “Aesthetic surgery“). In tumescent local anesthesia (TLA), the first step is to infuse one and a half to several liters of a mixture of sterile, isotonic water, sodium bicarbonate, the local anesthetic (medication used for local anesthesia), and often some cortisone (medication with anti-inflammatory effects) into the subcutaneous fat tissue. After a 30-minute waiting period, the infused fluid is evenly distributed in the fatty tissue. A kind of emulsion of fat cells and tumescent solution is formed, which greatly facilitates liposuction.
After the operation
Patients should be monitored in the recovery room for approximately 3 hours postoperatively. Close follow-up, especially monitoring of the cardiovascular system, is recommended in all cases. In addition, medical care should be provided for at least 6 hours after surgery, and for 24 hours after major surgery.
Potential complications
- Fat embolisms – Due to liposuction, fat embolisms (fatty tissue that has entered the bloodstream and can block a vessel) can occur.
- Hypervolemia (increase in the volume of circulating, that is, in the bloodstream) – Due to the amount of injected irrigation solution, circulatory stress may occur due to increased circulating fluid volume.
- Pulmonary edema (“water in the lungs“) – as a result of hypervolemia.
- Systemic toxicity of the local anesthetic.
- Systemic effect of adrenaline with the consequence of cardiac arrhythmias possibly also ventricular fibrillation.