Tumescent Local Anesthesia

221 Pages·2001·9.11 MB·English

by  B. Sommer

C.W. Hanke B. Sommer G. Sattler (Eds.)
Tumescent LocalAnesthesia
Springer-Verlag Berlin Heidelberg GmbH
c.
W Hanke B. Sommer G. Sattler (Eds.)
Tumescent Local
Anesthesia
With 133 Figures, 121 in colour and 13 rabIes
, Springer
Dr. C. W. Hanke, MD
Laser & Skin Surgery, Center of Indiana
13450 N Meridian, Suite 355
Carmel, IN 46032, USA
Dr. med. B. Sommer
Rosenparkklinik GmbH
Fachklinik fiir ăsthetisch-operative Dermatologie
Heidelberger Landstr. 20
64297 Darmstadt, Germany
Dr. G. Sattler
Rosenparkklinik GmbH
Fachklinik fiir ăsthetisch-operative Dermatologie
Heidelberger Landstr. 20
64297 Darmstadt, Germany
ISBN 978-3-642-63063-7
Library of Congress Cataloging-in-Publication Data.
Tumeszenz-Lokalanăsthesie. English. Tumescent local anesthesia / [edited by] C. W. Hanke,
B. Sommer, G. Sattler. p. ; cm. Includes bibliographical references.
ISBN 978-3-642-63063-7 ISBN 978-3-642-56744-5 (eBook)
DOI 10.1007/978-3-642-56744-5
1. Tumescent local anesthesia.I. Hanke, C. W. (C. William), 1944-Il. Sommer B. (Boris)
III. Sattler, G. (Gerhard), 1955-[DNLM: 1. Anesthesia, Local--methods.] RD85.T85 T8613 2000
617.9'66--dc21
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under the German copyright Law.
© Springer-Veriag Berlin Heidelberg 2001
Originally published by Springer-Verlag Berlin Heidelberg New York in 2001
Softcover reprint of the hardcover Ist edition 2001
The use of general descriptive names, registered names, trademarks, etc. in this publication
does not imply, even in the absence of a specific statement, that such names are exempt from
the relevant protective laws and regulations and therefore free for general use.
Product liability: The publishers cannot guarantee the accuracy of any information about
dosage and application contained in this book. In every individual case the user must check
such informat ion by consult ing the relevant literature.
Cover degsin: de'blik, Berlin
Typesetting: Goldener Schnitt, Sinzheim
Printed on acid-free paper SPIN: 10735754 22/3130 543210
Contents
Part A Theory
IntroductionandDefinition
B.SOMMER,C.W.HANKE,G.SATTLER 3
2 Historical Background
D.BERGFELD,C.W.HANKE ...•..................... 5
2.1 EvolutionofTumescentTechnique . 5
2.2 TumescentAnesthesiain the USA . 5
2·3 TumescentAnesthesiainEurope . 6
3 CompositionoftheSolution
forTumescentAnesthesia
B.SOMMER,H.BREUNINGER ...............•....... 9
3·1 CarrierSolution . 9
}.I.1 PhysiologicSalineSolution . 9
3·1.2 Ringer's Solution . 9
3·2 LocalAnesthetic . 9
3·3 Vasoconstrictors . 10
3-4 Buffer . 10
3·5 Anti-inflammatoryAdditives . 10
3·6 Recipesfor TumescentSolution . 10
3·6.1 Recipes UsingSalineSolution . 10
3.6.2 Recipes UsingRinger'sSolution . 11
4 Pharmacology
S.SCHWARZ,D.BERGFELD,B.SOMMER •....••....••.. 14
4·1 Introduction . 14
4.2 General pharmacology . 14
4.2.1 Physicochemicalproperties . 14
4·2.2 MechanismofAction . 16
4·2·3 Absorption,Distribution,Metabolism,
and Elimination . 18
4·2-4 VasoconstrictorAdditives . 20
4·3 ClinicalPharmacologyofLidocaine
andPrilocaineinTLA . 20
4·3·1 Concentrationofthe TumescentSolution . 20
4·3·2 OnsetofAction . 21
4·3·3 DurationofAction . 21
VI Contents
4·3-4 InfiltrationRate . 22
4·3·5 BloodandPlasmaLevels . 22
4·3·6 AntibacterialEffects . 23
4·3·7 AntithromboticEffects . 24
4·3·8 TemperatureoftheTumescentSolution . 24
4·3·9 Shelf-LifeoftheTumescentSolution . 24
5 Toxicology
S.SCHWARZ,S.RAPPRICH ....•..••...•...•...•..... 28
5·1 SystemicToxicity . 28
5·1.1 CNS Reactions . 29
5·1.2 CardiovascularReactions . 29
5.2 LocalTissueToxicity . 30
5·3 HypersensitivityReactions . 30
5·4 MethemoglobinFormation . 31
5·5 LocalAnestheticToxicityinTLA . 32
5·6 Conclusion . 33
6 SedationandAnalgesia
D.BERGFELD,B.SOMMER ••.•...••..••..•••..••..•• 35
6.1 PerioperativeSedation . 38
6.1.1 Benzodiazepines . 38
6.1.2 Neuroleptics . 39
6.2 PerioperativeAnalgesia . 40
6.2.1 PeripheralAnalgesics . 41
6.2.2 CentralAnalgesics . 41
7 PreventionofInfectionandThrombosis
D.BERGFELD,B.SOMMER ..•...••..••..••...•...... 44
7·1 PerioperativeInfectionProphylaxis . 44
7.2 PerioperativeThrombosisProphylaxis . 44
8 AdvantagesandDisadvantagesofTLA
B.SOMMER .......•••.••.••..•••......••...•...•. 47
8.1 SpecificAdvantagesofTLA . 47
8.1.1 SizeoftheAnesthetizedArea . 47
8.1.2 Safety . 47
8·1.3 Hydrodissection . 48
8.1.4 Hemostasis . 48
8.1.5 AnalgesicEffects . 49
8.1.6 Postoperative Complications . 49
8.1.7 Intraoperative FluidLoss . 49
8.1.8 ComparisonofTumescentAnesthesia
andGeneralAnesthesia . 49
8.2 SpecificDisadvantagesofTLA . 50
8.2.1 TLAFluidintheSurgicalSite . 50
8.2.2 InfiltrationTime . 50
Contents VII
8.2.3 DisadvantagesDueto InsufficientSedation 50
8.2.4 PatientManagementDuringSurgery 51
8.2.5 ChangesinSkinRelief. ............................ 51
8.2.6 IdentifyingSourcesofBleeding ..................... 51
PartB Practical Application
9 InfiltrationTechnique
D.BERGFELD,B.SOMMER,G.SATTLER 55
9.1 ManualInfiltration 56
9.2 MechanicalInfiltration 57
9.3 TemporalDynamicsofInfiltration 60
10 Techniqueof SubcutaneousInfusionAnesthesia
H.BREUNINGER 61
10.1 Introduction. .................................... 61
10.2 Method 62
10.2.1 PumpRequirements 62
10.2.2 Cannulas 63
10.2.3 AnestheticSolution 63
10.2-4 Infusion Depth 63
10.2.5 InfusionVolumes 64
10.2.6 FlowRate 64
10.2.7 WaitingPeriod 65
10.2.8 Medication 65
10.2.9 Monitoring 65
10.3 FurtherComments 65
11 PatientSelectionandPreoperativePreparation
D.BERGFELD,B.SOMMER.......................... 68
11.1 AreThereContraindicationsforTLA? 68
11.2 What PreliminaryTestsAre Necessary? 69
11.3 WhatSafetyPrecautionsShouldBeAvailable? 70
PartC Indications
12 Liposuction
B.SOMMER,G.SATTLER............................ 73
12.1 Technique. ...................................... 81
12.2 SpecificAdvantages 83
12.3 SpecificDisadvantages 84
13 Lipomas
M.SIMON........................................ 91
13.1 Technique. ...................................... 92
VIII Contents
13.2 SpecificAdvantages 95
13.3 SpecificDisadvantages 97
14 LargeExcisions
B.SOMMER,D.BERGFELD 98
14.1 Technique. ...................................... 98
14.2 SpecificAdvantages 100
14.3 Specific Disadvantages 100
15 Abdominoplasty
B.BLUGERMAN,D.SCHAVELZON .............•...... 102
15.1 Technique. ...................................... 103
15.2 SpecificAdvantages 104
15.3 Specific Disadvantages 106
16 MedialThighLift
G.SATTLER,B.SOMMER ..........•........•..•..... 107
16.1 Technique. ...................................... 107
16.2 SpecificAdvantages·............................... 108
16.3 Specific Disadvantages 108
17 TumescentFacelift
D.SPENCER,C.W.HANKE 109
17.1 Technique. ...................................... 109
17.2 SpecificAdvantages 112
18 SkinFlaps
S.SATTLER ....................................... 113
18.1 Technique. ...................................... 113
18.2 SpecificAdvantages 114
19 Split-ThicknessGrafts
B.SOMMER 117
19.1 Technique. ...................................... 117
19.2 SpecificAdvantages 118
20 Dermabrasion
A.PICOTO ...•.......................•........... 120
20.1 Technique. ...................................... 120
20.2 SpecificAdvantages 122
21 LaserSkinResurfacing
A.FRATILA,B.SOMMER .......••.•. 126
21.1 Indicationsfor LaserSkinResurfacing ............... 126
21.2 Technique. ...................................... 127
21.3 SpecificAdvantages 128
Contents IX
22 AxillaryHyperhidrosis
E.HASCHE 133
22.1 Technique. ...................................... 133
22.2 SpecificAdvantages 134
22.3 Specific Disadvantages 135
23 AcneInversa
M.HAGEDORN 137
23.1 Technique. ...................................... 138
23.2 SpecificAdvantages 139
23·3 Specific Disadvantages 139
24 HairTransplantation
M.SANDHOFER 142
24.1 Technique. ...................................... 142
24.2 SpecificAdvantages 146
24.3 Specific Disadvantages 147
25 BreastSurgery
R.KUNER 148
25.1 "BodySculpturing":TumescentLiposuction
inAutologous BreastReconstruction 148
25.2 Technique. ...................................... 149
25.3 SpecificAdvantages 152
25.4 SpecificDisadvantages 152
26 Arthroscopy
R.ERNST 153
26.1 Technique. ...................................... 153
26.2 SpecificAdvantages 155
27 SentinelNode Biopsy
H.BREUNINGER 156
27.1 Technique. ...................................... 156
27.2 SpecificAdvantagesand Disadvantages 158
28 HighLigationandStripping
oftheLongSaphenousVein
B.SOMMER,G.SATTLER. ........................... 160
28.1 Technique. ...................................... 160
28.2 SpecificAdvantages 163
28.3 Specific Disadvantages 165
29 HighLigationandStripping
oftheSmallSaphenousVein
R.]OKISCH 171
29.1 Technique. ...................................... 171
x Contents
29.2 SpecificAdvantages 172
29.3 SpecificDisadvantages 173
30 Phlebectomy
A.FRATILA 174
30.1 Technique. ...................................... 176
30.2 SpecificAdvantages 178
30.3 SpecificDisadvantages 180
31 EndoscopicDissectionofPerforatorVeins
G.SATTLER,B.SOMMER. ........................... 182
31.1 Indications. ..................................... 182
31.2 Complications.................................... 182
31.3 Technique. ...................................... 182
31.4 SpecificAdvantages 184
31.5 SpecificDisadvantages 184
32 Fasdotomy
G.SATTLER 186
32.1 Technique. ...................................... 186
32.2 SpecificAdvantages 187
32.3 SpecificDisadvantages 187
33 DebridementofVenousUlcers
M.AUGUSTIN,W.VANSCHEIDT 188
32.1 Technique. ...................................... 188
32.2 SpecificAdvantages 189
32.3 SpecificDisadvantages 189
32.4 ClinicalStudy 189
34 ShaveTherapyfor CruralUlcers
W.SCHMELLER 193
34.1 ShaveTherapy 193
34.2 Technique 196
34.3 SpecificAdvantages 202
34.4 SpecificDisadvantages 202
35 LocalAnesthesiainChildren
H.BREUNINGER 204
PartA:ToxicityofLidocaineinCorrelationto the PlasmaLevel 209
PartB:PossibleToxicsideEffectsofTLAandtheirTherapy .. 210
PartC:ListofSuppliers .................................. 211