Picture of Dr. Jeffrey A. Klein teaching surgeons Tumescent Liposuction

 

Tumescent Technique – Tumescent Anesthesia and Microcannular Liposuction by Jeffrey A. Klein, M.D.

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This Liposuction Textbook was written by the inventor of Tumescent Local Anesthesia and Tumescent Liposuction, Dr. Jeffrey A. Klein.

Published in 2000
470 pages

Table of Contents

Appendix

PART I FOUNDATIONS AND ISSUES

Chapter 1 – History of Tumescent Liposuction
Chapter 2 – Two Standards of Care for Liposuction
Chapter 3 – Ethical Considerations
Chapter 4 – Educational And Clinical Qualifications
Chapter 5 – Problems in Reporting Liposuction Deaths

PART II PATHOPHYSIOLOGY AND COMPLICATIONS

Chapter 6 – Clinical Biostatistics of Safety
Chapter 7 – Risks of Systemic Anesthesia
Chapter 8 – Miscellaneous Complications
Chapter 9 – Superwet Liposuction and Pulmonary Edema
Chapter 10 – Thrombosis and Embolism
Chapter 11 – Postliposuction Edema
Chapter 12 – Infections
Chapter 13 – Hypothermia and Cryoanesthesia
Chapter 14 – Perioperative Bleeding Disorders
Chapter 15 – Maximum Safe Dosage of Lidocaine

PART III CLINICAL PHARMACOLOGY

Chapter 16 – Pharmacology of Tumescent Technique
Chapter 17 – Pharmacology of Lidocaine
Chapter 18 – Cyrtochrome P450 3A4 and Lidocaine Metabolism
Chapter 19 – Pharmacokinetics of Tumescent Lidocaine
Chapter 20 – Lidocaine Toxicity and Drug Interactions
Chapter 21 – Maximum Recommended Dosage of Tumescent Lidocaine
Chapter 22 – Bupivacaine, Prilocaine, and Ropivacaine
Chapter 23 – Tumescent Formulations
Chapter 24 – Ancillary Pharmacology

PART IV FUNDAMENTAL ASPECTS OF TUMESCENT LIPOSUCTION

Chapter 25 – Subcutaneous Fat: Anatomy and Histology
Chapter 26 – Tumescent Infiltration Technique
Chapter 27 – Microcannulas
Chapter 28 – Surgical Technique: Microcannula Tumescent Liposuction
Chapter 29 – Critique of Ultrasonic Liposuction
Chapter 30 – Post-liposuction Care: Open Drainage and Bimodal Compression

PART V TUMESCENT LIPOSUCTION BY TREATED AREA

Chapter 31 – Abdomen
Chapter 32 – Lateral Thighs
Chapter 33 – Female Hips and Back and Male Flanks
Chapter 34 – Medial Thighs, Knees, and Anterior Thighs
Chapter 35 – Chin, Cheeks, and Jowl
Chapter 36 – Buttocks
Chapter 37 – Male Breasts
Chapter 38 – Female Breasts
Chapter 39 – Arms
Chapter 40 – Female Legs and Ankles
Front Matter
Index

Tumescent.Org is Dedicated to Information About Tumescent Anesthesia.

Tumescent.Org is an informational website intended to provide information about Tumescent Local Anesthesia (TLA) including history of local anesthesia, books and articles on local anesthesia, current applications, as well as recent and on-going research.

Tumescent Drug Delivery: Lidocaine & Beyond

Tumescent lidocaine anesthesia (TLA) was developed 30 years ago to allow successful liposuction procedures totally using local anesthesia. In decades since, Jeffrey A. Klein, MD, has expanded his knowledge of TLA so that it could potentially be used for other surgical procedures and to deliver new treatments for painful conditions.
Dr. Klein shared his experience with TLA Sunday when he presented the Eugene J. Van Scott Award for Innovative Therapy of the Skin and Phillip Frost Leadership Lecture, “Tumescent Drug Delivery: Lidocaine and Beyond.”
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Download the PDF version of Dr. Klein's presentation at the AAD

Estimated Maximal Safe Dosages of Tumescent Lidocaine

maximal-safe-dosage-lidocaine
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Jeffrey A. Klein, MD, MPH,*† and Daniel R. Jeske, PhD†

BACKGROUND: Tumescent lidocaine anesthesia consists of subcutaneous injection of relatively large volumes (up to 4 L or more) of dilute lidocaine (≤1 g/L) and epinephrine (≤1 mg/L). Although tumescent lidocaine anesthesia is used for an increasing variety of surgical procedures, the maximum safe dosage is unknown. Our primary aim in this study was to measure serum lidocaine concentrations after subcutaneous administration of tumescent lidocaine with and without liposuction. Our hypotheses were that even with large doses (i.e., >30 mg/kg), serum lidocaine concentrations would be below levels associated with mild toxicity and that the concentration-time profile would be lower after liposuction than without liposuction.

METHODS: Volunteers participated in 1 to 2 infiltration studies without liposuction and then one study with tumescent liposuction totally by local anesthesia. Serum lidocaine concentrations were measured at 0, 2, 4, 6, 8, 10, 12, 14, 16, 18, and 24 hours after each tumescent lidocaine infiltration. Area under the curve (AUC∞) of the serum lidocaine concentration-time profiles and peak serum lidocaine concentrations (Cmax) were determined with and without liposuction. For any given milligram per kilogram dosage, the probability that Cmax >6 μg/mL, the threshold for mild lidocaine toxicity was estimated using tolerance interval analysis.

RESULTS: In 41 tumescent infiltration procedures among 14 volunteer subjects, tumescent lidocaine dosages ranged from 19.2 to 52 mg/kg. Measured serum lidocaine concentrations were all <6 μg/mL over the 24-hour study period. AUC∞s with liposuction were significantly less than those without liposuction (P = 0.001). The estimated risk of lidocaine toxicity without liposuction at a dose of 28 mg/kg and with liposuction at a dose of 45 mg/kg was ≤1 per 2000.

CONCLUSIONS: Preliminary estimates for maximum safe dosages of tumescent lidocaine are 28 mg/kg without liposuction and 45 mg/kg with liposuction. As a result of delayed systemic absorption, these dosages yield serum lidocaine concentrations below levels associated with mild toxicity and are a nonsignificant risk of harm to patients. (Anesth Analg 2016;122:1350–9)

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TAD Tumescent Antibiotic Delivery - Abdomen

Dr. Jeffrey Klein explains the theoretical concepts relating to tumescent antibiotic delivery and demonstrates the technique using SubQKath cannulas.

Painless Tumecent Infiltration

Jeffrey Klein MD shares his expertise in tumescent lidocaine local anesthesia of the abdomen using a Klein peristaltic pump and Monty infiltration cannulas.

News

.09 Saline Shortage

There is currently a shortage of sterile 0.9% Saline for IV infusion in 1 liter plastic IV bags. This shortage affects surgical procedures that use tumescent local anesthesia. The FDA is working to alleviate this shortage. Learn more here:
FDA updates on saline drug shortage

Articles

FDA 2010 Approved Lidocaine Epinephrine Labeling

Download the FDA approved insert for Lidocaine Hydrochloride and Epinephrine Injection, USP For Infiltration and Nerve Block.
FDA 2010 Approved Lidocaine Epinephrine Labeling

Books

XYLOCAINE – CHEMISTRY, PHARMACOLOGY
AND CLINICAL APPLICATIONS – Lofgren, Lundqvist 

Preface
The scientific and clinical development of Xylocaine has been as remarkable as it has been rapid, Synthesized
only as recently as 1943, it is currently regarded as one of the safest and most reliable of the local anesthetics that are in common use today.

Articles

FDA Lidocaine Analysis Documents

The complete collection of documents containing the data upon which the FDA based its official 7mg/kg maximum recommended dosage for lidocaine with epinephrine for infiltration local anesthesia (obtained under the Freedom of Information Act).
FDA Lidocaine Analysis Documents