Safety of Tumescent Liposuction Compared with Liposuction in Systemic Sedation or General Anesthesia—A Review of the Literature

Abstract

Introduction: Liposuction surgery is increasing in frequency and is currently the most commonly performed cosmetic procedure. In tumescent liposuction, the unwanted fat deposits are injected with tumescence fluid containing saline, epinephrine, and lidocaine, the latter used as the only source of pain control. Tumescent liposuction has to be clearly distinguished from liposuction, where tumescent solution is locally applied, but pain is controlled with systemic sedation (oral, intramuscular, or intravenous sedation, rarely spinal sedation), or general anesthesia. Methods: In this study, the different anesthesiologic techniques currently used for liposuction are compared with regard to safety. Reported fatalities attributed to liposuction were reviewed, and it was determined, whether tumescent liposuction was performed or whether liposuction was assisted with systemic sedation or general anesthesia. Results: To date, no fatalities have been reported in tumescent liposuction and only minor complications have been described. The safety of tumescent liposuction could be demonstrated in 396,457 reported cases (including own data) performed in either an office-based or a hospital setting. Fatalities (n = 110), however, have been reported when pain was controlled by systemic sedation or when general anesthesia was applied. A mortality rate of 2.6–19.1 per 100,000 cases was calculated. Conclusion: Based on these findings, it is concluded that tumescent liposuction is currently the safest anesthesiologic technique for liposuction surgery because it is impossible to perform liposuction beyond infiltrated areas and because only smaller volumes of fat can be removed. To ensure safety, lidocaine levels should not exceed limits (35–55 mg/kg body weight). Removal of larger fat volumes should be performed in more than one procedure. Intravenous sedation or general anesthesia should be more carefully considered for this cosmetic procedure.