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Local and Regional Anesthesia in Plastic Surgery: Safety Considerations and Management of Adverse Events

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References

  1. Rao RB, Ely SF, Hoffman RS. Deaths related to liposuction. N Engl J Med. 1999;340:1471–5.

    Article  CAS  PubMed  Google Scholar 

  2. Pitman GH, Aker JS, Tripp ZD. Tumescent liposuction. A surgeon’s perspective. Clin Plast Surg. 1996;23:633–41.

    CAS  PubMed  Google Scholar 

  3. Gilliland MD, Coates N. Tumescent liposuction complicated by pulmonary edema. Plast Reconstr Surg. 1997;99:215–9.

    Article  CAS  PubMed  Google Scholar 

  4. Grazer FM, Meister FL. Complications of the tumescent formula for liposuction. Plast Reconstr Surg. 1997;100:1893–6.

    Article  CAS  PubMed  Google Scholar 

  5. Schecter WP, Swisher JL. Local anesthesia in surgical practice. Curr Probl Surg. 2000;37:10–67.

    Article  CAS  PubMed  Google Scholar 

  6. Iverson RE, Pao VS. MOC-PS(SM) CME article: liposuction. Plast Reconstr Surg. 2008;121:1–11.

    Article  PubMed  Google Scholar 

  7. JA K. Tumescent technique chronicles. Local anesthesia, liposuction, and beyond. Dermatol Surg. 1995;21:449–57.

    Google Scholar 

  8. Klein JA. Tumescent technique for local anesthesia improves safety in large-volume liposuction. Plast Reconstr Surg. 1993;92:1085–98.

    Article  CAS  PubMed  Google Scholar 

  9. Brunton LL, Chabner BA, Knollman BC. Goodman & Gilman’s the pharmacological basis of therapeutics. 12th ed. New York: McGraw-Hill; 2011.

    Google Scholar 

  10. Jeske AH. Xylocaine: 50 years of clinical service to dentistry. Tex Dent J. 1998;115:9–13.

    CAS  PubMed  Google Scholar 

  11. Lalonde DH. Wide-awake flexor tendon repair. Plast Reconstr Surg. 2009;123:623–5.

    Article  CAS  PubMed  Google Scholar 

  12. Ilyas EN, Leinberry CF, Ilyas AM. Skin cancers of the hand and upper extremity. J Hand Surg Am. 2012;37:171–8.

    Article  PubMed  Google Scholar 

  13. Klein JA. Tumescent technique for regional anesthesia permits lidocaine doses of 35 mg/kg for liposuction. J Dermatol Surg Oncol. 1990;16:248–63.

    Article  CAS  PubMed  Google Scholar 

  14. Beck-Schimmer B, Pasch T. Tumescent technique for local anesthesia. Anasthesiol Intensivmed Notfallmed Schmerzther. 2002;37:84–8.

    Article  CAS  PubMed  Google Scholar 

  15. Ostad A, Kageyama N, MOY RL. Tumescent anesthesia with a lidocaine dose of 55 mg/kg is safe for liposuction. Dermatol Surg. 1996;22:921–7.

    CAS  PubMed  Google Scholar 

  16. Coleman III WP. Tumescent anesthesia with a lidocaine dose of 55 mg/kg is safe for liposuction. Dermatol Surg. 1996;22:919.

    Article  PubMed  Google Scholar 

  17. Burk III RW, Guzman-Stein G, Vasconez LO. Lidocaine and epinephrine levels in tumescent technique liposuction. Plast Reconstr Surg. 1996;97:1379–84.

    Article  PubMed  Google Scholar 

  18. Swanson E. Prospective study of lidocaine, bupivacaine, and epinephrine levels and blood loss in patients undergoing liposuction and abdominoplasty. Plast Reconstr Surg. 2012;130:702–22.

    Article  CAS  PubMed  Google Scholar 

  19. Covino BG. Handbook of epidural anesthesia and analgesia. New York: Grune & Stratton; 1985.

    Google Scholar 

  20. Covino BG. Physiologic disposition of local anesthetic agents. Reg Anesth. 1977;2:6–7.

    Google Scholar 

  21. Michaels BM, Eko FN. Outpatient abdominoplasty facilitated by rib blocks. Plast Reconstr Surg. 2009;124:635–42.

    Article  CAS  PubMed  Google Scholar 

  22. Mustoe TA, Kim P, Schierle CF. Outpatient abdominoplasty under conscious sedation. Aesthet Surg J. 2007;27:442–9.

    Article  CAS  PubMed  Google Scholar 

  23. Rosenberg MH, Palaia DA, Bonanno PC. Abdominoplasty with procedural sedation and analgesia. Ann Plast Surg. 2001;46:485–7.

    Article  CAS  PubMed  Google Scholar 

  24. Lalonde DH. “Hole-in-one” local anesthesia for wide-awake carpal tunnel surgery. Plast Reconstr Surg. 2010;126:1642–4.

    Article  CAS  PubMed  Google Scholar 

  25. Lalonde DH. Reconstruction of the hand with wide awake surgery. Clin Plast Surg. 2011;38:761–9.

    Article  PubMed  Google Scholar 

  26. Chan ZH, Balakrishnan V, McDonald A. Short versus long-acting local anaesthetic in open carpal tunnel release: which provides better preemptive analgesia in the first 24 hours? Hand Surg. 2013;18:45–7.

    Article  CAS  PubMed  Google Scholar 

  27. BOYES JH. Bunnell’s surgery of the hand. Philadelphia: Lippincott; 1970.

    Google Scholar 

  28. Surgery of the hand and upper extremity. McGraw-Hill: New York, 1996.

    Google Scholar 

  29. Thomson CJ, Lalonde DH, Denkler KA, Feicht AJ. A critical look at the evidence for and against elective epinephrine use in the finger. Plast Reconstr Surg. 2007;119:260–6.

    Article  CAS  PubMed  Google Scholar 

  30. Lalonde D, Bell M, Benoit P, Sparkes G, Denkler K, Chang P. A multicenter prospective study of 3110 consecutive cases of elective epinephrine use in the fingers and hand: the Dalhousie Project clinical phase. J Hand Surg Am. 2005;30:1061–7.

    Article  PubMed  Google Scholar 

  31. Keramidas EG, Rodopoulou SG. Ropivacaine versus lidocaine in digital nerve blocks: a prospective study. Plast Reconstr Surg. 2007;119:2148–52.

    Article  CAS  PubMed  Google Scholar 

  32. Brody GS. The tumescent technique for face lift. Plast Reconstr Surg. 1994;94:407.

    Article  CAS  PubMed  Google Scholar 

  33. Latrenta GS. Tumescent cervicofacial rhytidectomy. Aesthet Surg J. 1998;18:423–30.

    Article  CAS  PubMed  Google Scholar 

  34. Ramon Y, Barak Y, Ullmann Y, Hoffer E, Yarhi D, Bentur Y. Pharmacokinetics of high-dose diluted lidocaine in local anesthesia for facelift procedures. Ther Drug Monit. 2007;29:644–7.

    Article  CAS  PubMed  Google Scholar 

  35. Mesa JV, Vasconez LO. Face and neck-lifts under local anesthesia with neither IV sedation nor general anesthesia. American Association of Plastic Surgeons 92nd annual meeting. 2013; 20 April 2013.

    Google Scholar 

  36. Mesa JV, Vasconez LO Face-lift and neck-lift under local anesthesia with neither IV sedation nor general anesthesia. International confederation of plastic and reconstructive aesthetic surgery 17th World Congress. 2013; 25 Feb 2013.

    Google Scholar 

  37. Colque A, Eisemann ML. Breast augmentation and augmentation-mastopexy with local anesthesia and intravenous sedation. Aesthet Surg J. 2012;32:303–7.

    Article  PubMed  Google Scholar 

  38. Spear SL, Bulan EJ, Venturi ML. Breast augmentation. Plast Reconstr Surg. 2006;118:188S–96S.

    Article  CAS  PubMed  Google Scholar 

  39. Lai CS, Yip WH, Lin SD, Chou CK, Tseng CK. Continuous thoracic epidural anesthesia for breast augmentation. Ann Plast Surg. 1996;36:113–6.

    Article  CAS  PubMed  Google Scholar 

  40. Gardiner S, Rudkin G, Cooter R, Field J, Bond M. Paravertebral blockade for day-case breast augmentation: a randomized clinical trial. Anesth Analg. 2012;115:1053–9.

    Article  CAS  PubMed  Google Scholar 

  41. Huang TT, Parks DH, Lewis SR. Outpatient breast surgery under intercostal block anesthesia. Plast Reconstr Surg. 1979;63:299–303.

    Article  CAS  PubMed  Google Scholar 

  42. Shimizu Y, Nagasao T, Taneda H, Sakamoto Y, Asou T, Imanishi N, Kishi K. Combined usage of intercostal nerve block and tumescent anaesthesia: an effective anaesthesia technique for breast augmentation. J Plast Surg Hand Surg. 2014;48:51–5.

    Article  PubMed  Google Scholar 

  43. Mulroy MF. Systemic toxicity and cardiotoxicity from local anesthetics: incidence and preventive measures. Reg Anesth Pain Med. 2002;27:556–61.

    Article  CAS  PubMed  Google Scholar 

  44. Englesson S, Grevsten S. The influence of acid-base changes on central nervous system toxicity of local anaesthetic agents II. Acta Anaesthesiol Scand. 1974;18:88–103.

    Article  CAS  PubMed  Google Scholar 

  45. Kairaluoma PM, Bachmann MS, Korpinen AK, Rosenberg PH, Pere PJ. Single-injection paravertebral block before general anesthesia enhances analgesia after breast cancer surgery with and without associated lymph node biopsy. Anesth Analg. 2004;99:1837–43. table

    Article  PubMed  Google Scholar 

  46. Albright GA. Cardiac arrest following regional anesthesia with etidocaine or bupivacaine. Anesthesiology. 1979;51:285–7.

    Article  CAS  PubMed  Google Scholar 

  47. Vijay BS, Mitra S, Jamil SN. Refractory cardiac arrest due to inadvertent intravenous injection of 0.25 % bupivacaine used for local infiltration anesthesia. Anesth Essays Res. 2013;7:130–2.

    Article  PubMed  PubMed Central  Google Scholar 

  48. Graf BM, Abraham I, Eberbach N, Kunst G, Stowe DF, Martin E. Differences in cardiotoxicity of bupivacaine and ropivacaine are the result of physicochemical and stereoselective properties. Anesthesiology. 2002;96:1427–34.

    Article  CAS  PubMed  Google Scholar 

  49. Fayman M, Beeton A, Potgieter E, Becker PJ. Comparative analysis of bupivacaine and ropivacaine for infiltration analgesia for bilateral breast surgery. Aesthetic Plast Surg. 2003;27:100–3.

    Article  PubMed  Google Scholar 

  50. Kakagia D, Fotiadis S, Tripsiannis G. Levobupivacaine versus ropivacaine infiltration analgesia for mastopexy: a comparative study of 2 long-acting anesthetic drugs in infiltrative anesthesia for mastopexy. Ann Plast Surg. 2005;55:258–61.

    Article  CAS  PubMed  Google Scholar 

  51. Bourne E, Wright C, Royse C. A review of local anesthetic cardiotoxicity and treatment with lipid emulsion. Local Reg Anesth. 2010;3:11–9.

    CAS  PubMed  PubMed Central  Google Scholar 

  52. Man D, Podichetty VK. Lipid rescue in resuscitation of local anesthetic-induced cardiac arrest in aesthetic surgery. Plast Reconstr Surg. 2010;125:257e–9e.

    Article  CAS  PubMed  Google Scholar 

  53. Naja Z, PA L. Somatic paravertebral nerve blockade. Incidence of failed block and complications. Anaesthesia. 2001;56:1184–8.

    Article  CAS  PubMed  Google Scholar 

  54. Schnabel A, Reichl SU, Kranke P, Pogatzki-Zahn EM, Zahn PK. Efficacy and safety of paravertebral blocks in breast surgery: a meta-analysis of randomized controlled trials. Br J Anaesth. 2010;105:842–52.

    Article  CAS  PubMed  Google Scholar 

  55. Shkol’nik LD, Vasil’ev VI, Soboleva LV. Multi-injection thoracic paravertebral anesthesia during breast cancer operations. Anesteziol Reanimatol 2006; 80–5.

    Google Scholar 

  56. Burlacu CL, Buggy DJ. Coexisting harlequin and Horner syndromes after high thoracic paravertebral anaesthesia. Br J Anaesth. 2005;95:822–4.

    Article  CAS  PubMed  Google Scholar 

  57. Cooter RD, Rudkin GE, Gardiner SE. Day case breast augmentation under paravertebral blockade: a prospective study of 100 consecutive patients. Aesthetic Plast Surg. 2007;31:666–73.

    Article  PubMed  Google Scholar 

  58. Hidalgo DA. Breast augmentation: choosing the optimal incision, implant, and pocket plane. Plast Reconstr Surg. 2000;105:2202–16.

    Article  CAS  PubMed  Google Scholar 

  59. Hidalgo DA, Pusic AL. The role of methocarbamol and intercostal nerve blocks for pain management in breast augmentation. Aesthet Surg J. 2005;25:571–5.

    Article  CAS  PubMed  Google Scholar 

  60. Selander D, Dhuner KG, Lundborg G. Peripheral nerve injury due to injection needles used for regional anesthesia. An experimental study of the acute effects of needle point trauma. Acta Anaesthesiol Scand. 1977;21:182–8.

    Article  CAS  PubMed  Google Scholar 

  61. Porter JM. A prospective audit of regional anaesthesia for hand surgery. Ann R Coll Surg Engl. 1992;74:89–94.

    CAS  PubMed  PubMed Central  Google Scholar 

  62. Chaput B, Fade G, Andre A, Grolleau JL, Garrido I. Liposuction: an exceptional case of skin necrosis secondary to an error of infiltration. Plast Reconstr Surg. 2012;129:765e–6e.

    Article  CAS  PubMed  Google Scholar 

  63. Kerfant N, Philandrianos C, Alliez A, Casanova D. Inadvertent subcutaneous injection of hypertonic saline solution during lipofilling. Aesthetic Plast Surg. 2013;37:709–10.

    Article  CAS  PubMed  Google Scholar 

  64. Kaye AD, Eaton WM, Jahr JS, Nossaman BD, Youngberg JA. Local anesthesia infiltration as a cause of intraoperative tension pneumothorax in a young healthy woman undergoing breast augmentation with general anesthesia. J Clin Anesth. 1995;7:422–4.

    Article  CAS  PubMed  Google Scholar 

  65. Osborn JM, Stevenson TR. Pneumothorax as a complication of breast augmentation. Plast Reconstr Surg. 2005;116:1122–6.

    Article  CAS  PubMed  Google Scholar 

  66. Terheggen MA, Wille F, Borel RI, TI I, JT K. Paravertebral blockade for minor breast surgery. Anesth Analg. 2002;94:355–9. table

    PubMed  Google Scholar 

  67. Ramirez OM, Galdino G. Does tumescent infiltration have a deleterious effect on undermined skin flaps? Plast Reconstr Surg. 1999;104:2269–72.

    Article  CAS  PubMed  Google Scholar 

  68. Campbell JR, Maestrello CL, Campbell RL. Allergic response to metabisulfite in lidocaine anesthetic solution. Anesth Prog. 2001;48:21–6.

    CAS  PubMed  PubMed Central  Google Scholar 

  69. Speca SJ, Boynes SG, Cuddy MA. Allergic reactions to local anesthetic formulations. Dent Clin North Am. 2010;54:655–64.

    Article  PubMed  Google Scholar 

  70. Anantharaman V, Gunasegaran K. Advanced Cardiac Life Support guidelines 2011. Singapore Med J. 2011;52:548–55.

    CAS  PubMed  Google Scholar 

  71. Hutton D. Cardiac arrest and the 2010 advanced cardiac life support guidelines--part IV. Plast Surg Nurs. 2011;31:169–73.

    Article  PubMed  Google Scholar 

  72. Giordano S, Verajankorva E, Koskivuo I, Suominen E. Effectiveness of local anaesthetic pain catheters for abdominal donor site analgesia in patients undergoing free lower abdominal flap breast reconstruction: a meta-analysis of comparative studies. J Plast Surg Hand Surg. 2013;47:428–33.

    PubMed  Google Scholar 

  73. Zhong T, Ojha M, Bagher S, Butler K, Srinivas C, McCluskey SA, Clarke H, O’Neill AC, Novak CB, Hofer SO. Transversus abdominis plane block reduces morphine consumption in the early postoperative period following microsurgical abdominal tissue breast reconstruction: a double-blind, placebo-controlled, randomized trial. Plast Reconstr Surg. 2014;134:870–8.

    Article  CAS  PubMed  Google Scholar 

  74. Heller L, Kowalski AM, Wei C, Butler CE. Prospective, randomized, double-blind trial of local anesthetic infusion and intravenous narcotic patient-controlled anesthesia pump for pain management after free TRAM flap breast reconstruction. Plast Reconstr Surg. 2008;122:1010–8.

    Article  CAS  PubMed  Google Scholar 

  75. Smith MM, Lin MP, Hovsepian RV, Wood D, Nguyen T, Evans GR, Wirth GA. Postoperative seroma formation after abdominoplasty with placement of continuous infusion local anesthetic pain pump. Can J Plast Surg. 2009;17:127–9.

    Article  PubMed  PubMed Central  Google Scholar 

  76. Smith MM, Hovsepian RV, Markarian MK, Degelia AL, Paul MD, Evans GR, Wirth GA. Continuous-infusion local anesthetic pain pump use and seroma formation with abdominal procedures: is there a correlation? Plast Reconstr Surg. 2008;122:1425–30.

    Article  CAS  PubMed  Google Scholar 

  77. Aschenbrenner DS. A health advisory concerning topical anesthetics. Am J Nurs. 2009;109:30.

    Google Scholar 

  78. Shimron Y, Avery, S. Woman had no lidocaine order. News & Observer. 2005; Raleigh, NC, The News & Observer Publishing Co.

    Google Scholar 

  79. Grekin RC, Auletta MJ. Local anesthesia in dermatologic surgery. J Am Acad Dermatol. 1988;19:599–614.

    Article  CAS  PubMed  Google Scholar 

  80. Rosenberg PH, Veering BT, Urmey WF. Maximum recommended doses of local anesthetics: a multifactorial concept. Reg Anesth Pain Med. 2004;29:564–75.

    CAS  PubMed  Google Scholar 

  81. Nystrom EU, Heavner JE, Buffington CW. Blood pressure is maintained despite profound myocardial depression during acute bupivacaine overdose in pigs. Anesth Analg. 1999;88:1143–8.

    Article  CAS  PubMed  Google Scholar 

  82. Perkins GD, Travers AH, Berg RA, Castren M, Considine J, Escalante R, Gazmuri RJ, Koster RW, Lim SH, Nation KJ, Olasveengen TM, Sakamoto T, Sayre MR, Sierra A, Smyth MA, Stanton D, Vaillancourt C. Part 3: adult basic life support and automated external defibrillation: 2015 International consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations. Resuscitation. 2015;95:e43–69.

    Article  PubMed  Google Scholar 

  83. de Jong RH, Heavner JE. Local anesthetic seizure prevention: diazepam versus pentobarbital. Anesthesiology. 1972;36:449–57.

    Article  PubMed  Google Scholar 

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Mesa, J., Lalonde, D., Vasconez, L.O. (2017). Local and Regional Anesthesia in Plastic Surgery: Safety Considerations and Management of Adverse Events. In: Finucane, B., Tsui, B. (eds) Complications of Regional Anesthesia. Springer, Cham. https://doi.org/10.1007/978-3-319-49386-2_25

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