Tumescent Lidocaine Anesthesia Video Tips

Dr. Jeffrey Klein is the inventor of Tumescent Lidocaine Anesthesia which he has developed over the last 15 years.

In these videos Dr. Klein shares his safety tips for using Tumescent Lidocaine Anesthesia to prevent any possible problems from using TLA in surgical procedures.

Tumescent Safety Tips - Legible Written Orders Absolutely Necessary

Dr. Jeffrey Klein explains how to avoid miscommunication between the surgeon and the person mixing the bag of tumescent lidocaine anesthesia.

Tumescent Safety Tips - Maximum Safe mg kg Dosage of TLA

Dr. Jeffrey Klein provides the maximum safe dosage of lidocaine for tumescent anesthesia for surgery with liposuction and without liposuction.

Tumescent Safety Tips - IV Access Highly Recommended

Dr. Jeffrey Klein explains why IV access is required when using tumescent local anesthesia.

Tumescent Safety Tips - IV Fluids Relatively Contraindicated

Dr. Jeffrey Klein advises caution to avoid using IV fluids if using large volume tumescent local anesthesia.

Tumescent Safety Tips - Orhtostatic Hypotension Unlikely a Fluid Deficit

Dr. Jeffrey Klein explains why to avoid IV fluids when treating orhtostatic hypotension because it is usually not due to volume depletion.

Tumescent Safety Tips - Use Safety Labels on TLA Bags

Dr. Jeffrey Klein recommends using safety labels on every bag of tumescent lidocaine anesthesia to avoid inadvertent IV delivery of tumescent lidocaine.

Tumescent Safety Tips - Use Lidocaine with Epinephrine Vials

Dr. Jeffrey Klein recommends using lidocaine with epinephrine in single commercial vials rather than using lidocaine and epinephrine in separate vials.

Tumescent Safety Tips - Preparation of TLA Solution

Dr. Jeffrey A. Klein recommends that the person who mixes the tumescent lidocaine anesthesia should be a licensed professional and should not be distracted during the preparation of the TLA solution.

Tumescent Safety Tips - Lidocaine Drug Interactions

Dr. Jeffrey Klein advises avoid drug interactions with lidocaine with drugs that block lidocaine metabolism.

Tumescent Safety Tips - Clonidine Blunts Epinephrine Tachycardia

Dr. Jeffrey Klein recommends using Clonidine to counteract the effects of Epinephrine.

Tumescent Safety Tips - Atropine Prevents Vaso Vagal Syncope

Dr. Jeffrey Klein recommends using Atropine to prevent Vaso Vagal Syncope during a surgical procedure using tumescent lidocaine anesthesia, TLA.

Tumescent Safety Tips - Use Warm TLA Solution

Dr Jeffrey Klein recommends using warm tumescent lidocaine anesthesia solution during a surgical procedure.

Tumescent Safety Tips - Lidocaine Safest Local Anesthetic

Dr.Jeffrey Klein cautions to use only Lidocaine in tumescent lidocaine anesthesia solution and to avoid using other types of local anesthetics.

Tumescent Safety Tips - Surgeon & Anesthesiologist Communication

Dr. Jeffrey Klein advises caution to both the surgeon and anesthesiologist to have responsibility for the patients well being when using tumescent lidocaine anesthesia, TLA.

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

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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.


.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


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



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.


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