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Local Anesthetic Use in Tumescent Liposuction: An American Society of Plastic Surgeons Survey

Paik, Angie M. MD*; Daniali, Lily N. MD; Lee, Edward S. MD; Hsia, Henry C. MD

doi: 10.1097/SAP.0000000000000420
Aesthetic Surgery

Background Current guidelines favor the use of lidocaine in liposuction wetting solutions. The use of bupivacaine as an alternative remains controversial despite reports of its use with safe and favorable outcomes suggesting faster postoperative recovery time secondary to improved pain control. The goals of this study were to determine the prevalence of bupivacaine use, examine liposuction practices of bupivacaine users, and elucidate opinions regarding bupivacaine use.

Methods An online survey was distributed to 2500 randomly selected members of the American Society of Plastic Surgeons. Data were collected and analyzed with special attention toward the practice and opinions of bupivacaine use.

Results The response rate of the survey met the average American Society of Plastic Surgeons online survey response rate at 12.8% (n = 320). Respondents (7.2%; n = 22) reported using bupivacaine in their wetting solutions (bupivacaine group) and provided a dosage range of 62.5 to 150 mg. Respondents (83.5%; n =254) reported using either lidocaine or prilocaine (no-bupivacaine group). There were no reports of bupivacaine toxicity in 2011. The demographic profile and liposuction practices of both groups were comparable. Although 36% of the no-bupivacaine group did not know or had no opinion on when it is appropriate to use bupivacaine in liposuction wetting solutions, 85% of this group has used bupivacaine for other clinical purposes.

Conclusions A review of 320 plastic surgeons’ experiences revealed that 7% of respondents are using bupivacaine in their tumescent solutions with no reported cases of toxicity. Bupivacaine users differed dramatically only in their opinion regarding the safety of bupivacaine in tumescent liposuction. The recent studies suggesting better postoperative pain control with bupivacaine along with the proportion of respondents reporting bupivacaine use call for distinct guidelines on bupivacaine use in liposuction. Further studies, including a rigorous clinical trial documenting the safety and efficacy of bupivacaine when compared with lidocaine, would be warranted.

From the *Department of Plastic and Reconstructive Surgery, Brown University Alpert Medical School, Providence, RI; †Division of Plastic Surgery, Department of Surgery, Rutgers New Jersey Medical School, Newark; and ‡Division of Plastic Surgery, Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ.

Received August 26, 2014, and accepted for publication, after revision, November 12, 2014.

Conflicts of interest and sources of funding: none declared.

Presented at the Northeastern Society of Plastic Surgeons 30th Annual Meeting in Washington DC and the 2013 American Society of Plastic Surgeons Annual Meeting in San Diego, CA.

Reprints: Henry C. Hsia, MD, One Robert Wood Johnson Place, Box 19, New Brunswick, NJ. E-mail:

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