How much tumescent fluid should be injected for liposuction of the abdomen?

     I perform liposuction of the abdomen and flanks and several other areas in one surgery, but there may be a reason to do less.Kenneth Hughes, MDLos Angeles, CA

When using tumescent local anesthesia for liposuction, trust what your doc tells you since he has your best interest at heart and knows your extenuating circumstances. Usually you can have roughly 6 liters of tumescent fluid injected at 1 procedure. 2% lidocaine comes as 20mg/ml.  We add 25 ml of this 2% lido to each liter of solution to make a 0.05% concentration which has 500mg lido per liter. The upper limit of safety for the lidocaine is 55mg/kg. You weigh 130 lbs which is 59 kg.  For extra safety, if we use 45mg/kg limit and take this times 59 kg, therefore we come up with 2655 mg of lido. Each liter of solution has 500mg of lido in it therefore 2655 divided by 500 mg/liter = 5.3 liters of solution. If you dilute the lido by 20 % further then you have 400 mg/liter lido which then 2655 mg divided by 400mg/liter comes out to 6.6 liter of solution you can get injected to cover more territory. All this depends on you having a normal liver functioning and not on any meds that affect the liver or other body lab abnormalities. IV sedation often accompanies the local tumescent anesthesia to make you more comfortable. This is only a brief explanation of tumescent fluids for lipo. Sincerely, David Hansen,MD

Only so much local anesthetic can be given at one time.  Every physician uses a little different recipe for tumescent.  If your doctor can only uses a certain amount, please listen to him.  He is trying to do your surgery as safely as possible.  If you choose general anesthesia, he can do more areas with less tumescent fluid.

The usual limitation with tumescent liposuction is not the total volume but rather the number of milligrams of lidocaine used.Most people use the Klein formula, which is 50 mL of 1% lidocaine for every liter of saline.There are also other additives such as epinephrine and sodium bicarbonate.Most plastic surgeons will use a maximum of 35 mg of lidocaine per kilogram of weight of the patient.For example, a 100 kg person could tolerate 3,500 mg of lidocaine. Using the Klein formula, this would be seven liters. In your case, based on the Klein formula, weighing 130 pounds combined with the 35 mg per kilogram, the maximum volume would be just over 4 L.There have been published studies showing it is safe to use as much as 50 mg per kilogram. That is an added 40% of local anesthesia. In your case, this would be 5.6 L.Some surgeons use a higher concentration of lidocaine in their tumescent solution. In those cases, lesser volumes are used.Every surgeon is different.Based on the above formulas, treating the full abdomen, including flanks, hips and waist, upper and lower abdomen, is done routinely.A typical 130 lbs patient in my practice would need 1-1.5 liters of tumescent solution for the upper and lower abdomen. Typically, I would use an additional liter for flanks, hips and waist for both sides. It is possible to remove as much as 5 L of fat while staying within safe parameters.Most patients need some level of sedation.Perhaps your surgeon was planning on not using any type of sedation, in which case he or she may have felt the need to use more lidocaine.I'm curious if your surgeon is a board-certified plastic surgeon.Your stated limitations seem rather timid.At the same time, safety is always number one.Best of luck,Mats Hagstrom, M.D.