What Are the Benifits of Regional Anesthesia over General Anesthesia for Tummy Tuck?
- Asked by creampie in East Orange NJ
- 3 years ago
some drs refer to a Tumescent approach when performing a tummy tuck where only the area being worked on is treated and that this is safer and helps to prevent clotting. are the benifits the same with the regional anesthesia?
Regional, Local, Tumescent or General Anesthesia with Tummy Tuck Surgery
Everything in life has benefits and drawbacks. The same is true in Surgery where we always need to balance the benefits, drawbacks, including potential complications, to our patients.
A few definitions of Anesthesia
ANESTHESIA = Absence of Feeling (including pain)
REGIONAL ANESTHESIA - anesthesia of as REGION of the body (arm, leg, etc). This term comprises many types of anesthesia methods divided by the place where they are applied CENTRAL (EPIDURAL, SPINAL blocks) VS. PERIPHERAL (such as LOCAL blocks (of which TUMESCENT local infiltration is but one), NERVE blocks, etc). In these cases the patient breathes on her own and may undergo ADDITIONALLY various degrees of sedation for comfort. These techniques require infusion of large doses of local anesthetics which may be toxic (seizures, cardiac arrest). Moreover, they do NOT work with all people and have a failure rate of up to 10% requiring increased sedation and sometimes conversion to general anesthesia AFTER the infusion of high doses of local anesthetics and long acting opiate or other sedatives.
GENERAL ANESTHESIA - The patient is asleep. Her breathing and oxygenation is supervised and controlled by the anesthesiologist.
The more complex and prolonged the operation, the more it depends on pulling on muscles (requiring them to be soft and noncontracting), the more potential recurring discomfort to the patient - General anesthesia becomes a better option.
With general anesthesia, the tummy muscles can be relaxed and brought MUCH tighter together than could ever be done under tumescent techniques. Moreover, the patient has no discomfort and the feeling and anxiety of work being done under the hood ("I wonder what they are doing to me now?" recurrent blood pressure raising thought).
Rather, than being limited to always using the same tool, a Plastic surgeon should have the judgment of a master painter; being able to reach for and use the best brush for the job.
If someone tells you I ALWAYS use XYZ anesthesia - he is a one brush painter. This could by choice but most likely, by LACK of choice. Plastic surgeons (= members of the ASPS, American Society of Plastic Surgeons - certified by the American Board of Plastic Surgery) are the ONLY surgeons ALLOWED to perform Plastic Surgery in Hospitals and Surgi-Centers (these facilities do not recognize other specialty doctors as adequately trained to risk having them perform Plastic procedures on their staffs). Real Plastic surgeons can CHOOSE any brush they want (any mode of anesthesia) for their patients DEPENDING on the particular case. On the other hand, non-plastic surgeons are forced to operate out of office based facilities where by law they cannot offer general anesthesia to their patients,. As a result, all they have is but one brush (regional / tumescent anesthesia). Understandably, if not exactly truthfully, they are usually the loudest promoters of the "supremacy" of regional (usually Tumescent)anesthesia for everything.
Your doctor should help you with the method of the anesthesia
You and your doctor should discuss the best anesthesia and surgical method based on the surgeons,anesthesiologist, and surgical centers capabilities. Each methods has its own positive and negative points and your surgeon after careful examination and evaluation would offer you the best.
Anesthesia for Tummy Tuck
Dr. Aldea is totally correct. Although I have the ability to use any type of anesthesia, and vary on occasion, I prefer general anesthesia. I find it much safer, allows me to obtain better results, and has a faster recovery than either regional or tumescent anesthesia. Before you consent to any anesthesia, check the privileges of the surgeon, facility, and anesthesia provider.
None that I know of
I know that some docs seem to promote regional anesthesia:however, I have been using general for years. My patients wake up happy with no pain. As long as the doctor has a certified OR and all the equipment to perform GA and an anesthesiologis -- the I think that general is the way to go.
Risks of clotting with General, Regional or Local Anesthesia.
Although many believe that regional anesthesia is as safe as local in terms of diminished tendency for DVT, it has never been truly proven to the best of my knowledge. To some degree there is pooling of blood with certain regional anesthetics such as a spinal that could actually increase the tendency for clotting. IF you are at high risk for DVT you may want to reconsider the procedure entirely.
Anesthesia for a tummy tuck
Please re-read Dr. Aldea's notes as they are excellent and do not need to be repeated by me. All I will add is to be aware that many non-plastic surgeons out there cannot get proper anesthesia doctors to work with them so they will resort to local, regional, or tumescent anesthesia. What is a crime about that is that they try to tell you that they do this because it is "safer" than something like a general anesthetic by a physician anesthesiologist. That is simply deceiving you for their own financial gain, not for your safety.
Anesthesia options for tummy tuck
There are 3 basic ways to provide anesthesia for a tummy tuck. When considering the important factors of safety and comfort, most often a general anesthetic is the first choice. A regional anesthetic such as an epidural is another way to go, but you would still need an anesthetist and IV sedation anyway. Tumescent anesthesia is most often used for liposuction, which does not involve the undermining, skin removal, and muscle tightening required for a good tummy tuck (though lipo is real surgery.) The blood vessel constriction from tumescent may provide temporary benefit in terms of less bleeding, but it also can compromise the blood circulation to the skin flap leading to healing problems. Blood loss from bleeding isn't really an issue with a properly done tummy tuck anyway. Further, it is theoretically possible that once the effect of the tumescent wears off, there could be an increased chance of bleeding because blood vessels relax and open up. So all, things considered, I think any potential benefits of tumescent for abdominoplasty are more than counteracted by risks.
Benifits of regional anesthesia over general anesthesia for tummy tuck
Enough stated by Dr Aldea! He hit a HOME RUN. To me there are no benefits using regional anesthesia in preforming a "full" tummy tuck. So why tight the surgeon's hands in getting the best result possible?
From MIAMI Dr. B
Differences between region and general anesthesia
It basically comes down to doctor and patient preference. Most doctors perform tummy tucks with general anesthesia, meaning that the patient is completely unconscience with a breathing tube inserted. Regional anesthesia involves using a local anesthetic agent in the area of surgery with the patient awake (sometimes IV sedation is used). No breathing tube is necessary. There are pros and cons of each, but from a safety point of view, as far as blood clot, bleeding, heart issues, I have not seen any studies that show one is safer than the other. You should feel comfortable with either choice so long as you are having surgery with a board-certified plastic surgeon and anesthesiologist. Good luck!
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.