Plastic and reconstructive surgery
-
Plast. Reconstr. Surg. · Jun 2005
The efficacy of continuous local anesthetic infiltration in breast surgery: reduction mammaplasty and reconstruction.
Pain control after reduction mammaplasty and breast reconstruction with tissue expanders often requires intravenous narcotic analgesia and inpatient hospitalization. Regional and local anesthetic techniques are increasing in popularity because they decrease the use of intravenous analgesic medications and offer comparable pain relief without the systemic side effects. ⋯ The continuous infiltration of local anesthetic with an infusion pump represents another tool for pain management in surgical patients.
-
Plast. Reconstr. Surg. · May 2005
Randomized Controlled TrialRapid absorption of tumescent lidocaine above the clavicles: a prospective clinical study.
Tumescent local anesthesia has been adapted for surgery of the face and neck, but there are no data regarding drug absorption when tumescent injection is used in this region. The aim of this study was to characterize the changes in plasma lidocaine concentrations over time when a tumescent solution is injected into the subcutaneous tissue of the neck. The study was carried out in human volunteer subjects, and injection of lidocaine to the thighs provided control data. ⋯ Tumescent injection above the clavicles results in a rapid rise in plasma lidocaine concentration when compared with injection to the lower extremities. Toxic symptoms could occur much earlier than expected for lower extremity tumescent anesthesia. In addition, dangerous plasma levels could occur if tumescent anesthesia in the lower extremities is followed by tumescent injection above the clavicles, because the absorption curves would be superimposed.
-
Plast. Reconstr. Surg. · May 2005
Current trends in local anesthesia in cosmetic plastic surgery of the head and neck: results of a German national survey and observations on the use of ropivacaine.
The goal of this study was to evaluate at the national level the current practice in the use of local anesthetics in cosmetic head and neck surgery and to compare the results with the novel local anesthesia technique used in the authors' department over the past 2 years. ⋯ The survey showed a clear trend toward the increasing use of local anesthetics in cosmetic surgery of the head and neck. Although the use of prilocaine and lidocaine prevailed, adverse cardiovascular reactions in up to 8.1 percent seem high for cosmetic procedures. Furthermore, the need of additional intraoperative top-up infiltration adds to an uncontrolled cumulative effect and patient discomfort. On the basis of their positive 2 years of experience with ropivacaine, the authors strongly believe that ropivacaine offers significant advantages, both in efficacy and prolonged duration of analgesia, while reducing the risk for adverse side effects due to lesser toxicity. This observation deserves further investigation in an established comparative study.