Department of Clinical Pharmacology, Wrocław University of Medicine, Bujwida 44, PL 50-345 Wrocław, Poland.
Pharmacol Rep. 2009 Jul-Aug;61(4):641-53. doi: 10.1016/s1734-1140(09)70116-1.
Tumescent local anesthesia is based upon the infusion of large volumes of neutralized anesthetic solutions, mainly lidocaine, at very low concentrations. This results in the paralysis of sensory nerve endings and minute nerve twigs, leading to a reduction in pain. The aim of this study was to assess the safety of lidocaine application in tumescent local anesthesia on different regions of patient's bodies. Measures of safety included the analysis of lidocaine concentrations and its pharmacokinetic parameters. In total, 48 patients were infused with tumescent anesthesia in the hypogastrium, buttocks and thighs, axillae, breasts, trunk, and face and neck areas. Lidocaine was infused in doses ranging from 5.2-40 mg/kg b.w., and in concentrations of 0.05% (hypogastrium, buttocks, thighs) or 0.1-0.15% (axillae, breasts, trunk, face, neck), using a total amount of 300-3200 mg. As the peak lidocaine concentration did not exceed 5 microg/ml (commonly known as the toxic threshold), the results of our study indicate that the doses used (not exceeding 40 mg/kg b.w.) are completely safe for patients undergoing tumescent anesthesia in different body areas. The observation of statistically significant correlations between both the dose and the total amount of lidocaine administered and its peak plasma concentration, together with the lack of correlations between the dose and the amount and the time taken to reach peak concentration, allows the safety of each anesthetic dose to be predicted. An analysis of the heterogeneous dynamics of lidocaine plasma concentration changes in tumescent anesthesia in different body areas indicates that both the rates and the degrees of absorption and elimination depend on the area of infiltration; this is in turn related to the vascularization of any given area. The study of lidocaine concentration and pharmacokinetic parameters also showed that there may potentially be a higher risk of a large anesthetic concentration developing within a short period of time during anesthesia of the upper parts of the body. During tumescent anesthesia, significantly higher plasma concentrations of lidocaine were observed in the face and neck than in the hypogastrium, buttocks and thighs, axillae, breast and trunk 0.5 to 4 h after its infusion. This indicates the need for carefully conducted patient observations immediately after infiltration into the aforementioned areas.
肿胀局部麻醉基于在非常低浓度下输注大量中和的麻醉溶液，主要是利多卡因，从而导致感觉神经末梢和微小神经分支麻痹，从而减轻疼痛。本研究的目的是评估利多卡因在肿胀局部麻醉中在患者身体不同部位应用的安全性。安全性措施包括分析利多卡因浓度及其药代动力学参数。共有 48 名患者在腹部，臀部和大腿，腋窝，乳房，躯干和面部及颈部区域接受肿胀麻醉。利多卡因的剂量范围为 5.2-40mg/kgbw，浓度为 0.05％（腹部，臀部，大腿）或 0.1-0.15％（腋窝，乳房，躯干，面部，颈部），使用总量 300-3200mg。由于峰值利多卡因浓度未超过 5μg/ml（通常称为毒性阈值），因此我们的研究结果表明，使用的剂量（不超过 40mg/kgbw）对在不同身体区域接受肿胀麻醉的患者是完全安全的。剂量和给予的利多卡因总量与其峰值血浆浓度之间存在统计学显著相关性的观察，以及剂量与达到峰值浓度的时间之间缺乏相关性，允许预测每个麻醉剂量的安全性。对肿胀麻醉中利多卡因血浆浓度变化的异质动力学的分析表明，吸收和消除的速度和程度都取决于渗透区域; 这反过来又与任何给定区域的血管化有关。对利多卡因浓度和药代动力学参数的研究还表明，在身体上部麻醉期间，短时间内可能会形成更高的麻醉浓度，从而存在更高的风险。在肿胀麻醉期间，与腹部，臀部和大腿，腋窝，乳房和躯干相比，在麻醉后 0.5 至 4 小时，面部和颈部的利多卡因血浆浓度明显更高。这表明需要在上述区域注入后立即仔细观察患者。
