Holt Natalie F
Department of Anesthesiology, Yale School of Medicine, New Haven, Connecticut, USA.
Curr Opin Anaesthesiol. 2017 Aug;30(4):518-524. doi: 10.1097/ACO.0000000000000486.
Tumescent anaesthesia is a method of administering dilute local anaesthetic into the subcutaneous tissue. Many anaesthesiologists are unfamiliar with the technique, its applications and potential risks.
The maximum safe dose of lidocaine with epinephrine in tumescent anaesthesia for liposuction is probably between 35 and 55 mg/kg. Without liposuction, the maximum dose of lidocaine with epinephrine should be no more than 28 mg/kg. After tumescent infiltration for liposuction, serum lidocaine concentrations peak between 12 and 16 h after injection. When tumescent lidocaine without epinephrine is used for endovenous laser therapy, peak serum lidocaine concentrations are observed much earlier, between 1 and 2 h after injection. Slow administration of more dilute concentrations of local anaesthetic decreases the risk of local anaesthetic systemic toxicity.
Although appealing because of its ability to provide prolonged analgesia, high doses of local anaesthetic are frequently administered using the tumescent technique, and absorption of local anaesthetic from the subcutaneous tissue is variable. When caring for patients having procedures in which tumescent anaesthesia is used, the risk of local anaesthetic toxicity should be acknowledged and lipid emulsion should be available for prompt treatment if needed.
肿胀麻醉是一种将稀释的局部麻醉药注入皮下组织的方法。许多麻醉医生对该技术、其应用及潜在风险并不熟悉。
肿胀麻醉用于吸脂时，利多卡因加肾上腺素的最大安全剂量可能在35至55毫克/千克之间。不进行吸脂时，利多卡因加肾上腺素的最大剂量不应超过28毫克/千克。吸脂进行肿胀浸润后，血清利多卡因浓度在注射后12至16小时达到峰值。当使用不含肾上腺素的肿胀利多卡因进行静脉内激光治疗时，血清利多卡因浓度峰值出现得更早，在注射后1至2小时之间。缓慢注射更稀释浓度的局部麻醉药可降低局部麻醉药全身毒性的风险。
尽管肿胀技术因其能够提供长时间镇痛而具有吸引力，但使用该技术时经常会给予高剂量的局部麻醉药，且局部麻醉药从皮下组织的吸收情况各不相同。在护理接受使用肿胀麻醉的手术患者时，应认识到局部麻醉药毒性的风险，并且如有需要，应备有脂质乳剂以便及时治疗。
