Zastosowanie znieczulenia tumescencyjnego – nowej metody znieczulenia nasiękowego

*Andrzej Bieniek¹, Krystyna Orzechowska-Juzwenko³, Jarosław Terpiński², Rafał Białynicki-Birula¹, Krystyna Głowacka³, Magdalena Hurkacz³

Summary
kin, the subcutaneous tissue, and venous system using infiltration of large volumes highly diluted, buffered solutions of local anaesthetics. The most commonly used preparation is the Klein solution, which contains 0.05% - 0.15% lidocaine buffered with 8.4% NaHCO₃ (10-20 ml l^-1) and 1:1 000 000- 1: 2 000 000 adrenaline. The most unusual aspect of this technique is the conscious overdose of local anaesthetic agent. Reported doses of lidocaine injected during TLA were between 35 and 55 mg kg^-1. The internationally accepted safe dose of lidocaine is 3 mg kg^-1, or 7 mg kg^-1 when combined with adrenaline. During standard infiltration anaesthesia the maximal absorption occurs after 1.5 to 2 hours, whereas during the tumescent technique maximal absorption is between 8 and 12 hours after injection. Absorption and elimination last for up to 48 hours, due to the slow circulation in anaesthetized tissues and the large fat solubility of lidocaine. As a result, larger doses of the drug are well tolerated.
In the preliminary study that will be reported in a separate paper, we assessed the plasma concentration of lidocaine in 19 patients who received lidocaine in doses varying from 5.2 to 44 mg kg^-1 for different surgical procedures. These included skin and subcutaneous tissue excisions, superficial skin reconstructions, axillary hyperhydrosis and suppurative hydradenitis, liposuction and dermabrasion. The maximal plasma concentrations varied from 0.43 to 3.9 ?g kg^-1 and never exceeded the potentially toxic concentration of 5 ?g kg^-1.
The warmed tumescent solution (250 to 6000 ml) is injected into subcutaneous tissue using a peristaltic pump or pressure bags over 30 minutes to 2 hours. Analgesia is achieved 10 to 20 minutes after injection and lasts for several hours. Moderate sedation is recommended due to the length of the procedure.
Because of possible complications, tumescent local anaesthesia should only be employed in outpatients with great care. Fluid overload may occur, and patients should be monitored during the procedure and for a sufficient period thereafter by adequately trained staff. Patients with cardiac or pulmonary risk factors should not undergo tumescent local anaesthesia

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