Research ArticlesOn Beyond Lidocaine Reconsidering Local Anesthetics in Tumescent Liposuction—A Critical ReviewHsia, Henry C. MDAuthor Information From the Section of Plastic Surgery, Yale School of Medicine, New Haven, CT. Received March 31, 2015, and accepted for publication, after revision November 9, 2015. Portions of this work were presented at the Fourth Congress of the World Association of Plastic Surgeons of Chinese Descent, November 2014, Hong Kong. Conflicts of interest and source of funding: none declared. Reprints: Henry C. Hsia, MD, Yale School of Medicine, Department of Surgery, Section of Plastic Surgery, Boardman Building 330, New Haven, CT 06520-8041. E-mail: [email protected]. Annals of Plastic Surgery: August 2016 - Volume 77 - Issue - p S66-S69 doi: 10.1097/SAP.0000000000000709 Buy Metrics Abstract The use of tumescent solution in liposuction is now considered standard of care; however, much debate still exists regarding its ideal components, especially surrounding the inclusion of local anesthetics. This article reviews the discussion regarding the use of local anesthetics in tumescent liposuction and how it may evolve in the future. The need for local anesthetic additives in tumescent liposuction has been questioned, and the use of longer-acting agents discouraged; however, increasing number of reports in recent years have described the increasingly widespread use of tumescent anesthesia where a wetting solution is infiltrated to achieve anesthesia in an operative field for procedures other than liposuction. More high-level evidence, such as randomized controlled clinical trials, will be required; however, it should be possible to develop a useful standardized algorithm that can guide surgeons to optimize patient safety as well as patient experience. Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.