In recent years it has been found that local anesthesia, which often suffices for surgery of the skin and superficial structures, can be adequately administered using large amounts of highly diluted anesthetic solutions combined with epinephrine. This has considerably increased application of local anesthesia in plastic surgery. Using one or more conventional infusion pumps for slow subcutaneous infusion anesthesia (SIA), we injected mixed anesthetic solutions painlessly and automatically into the subcutaneous layer. The local anesthetics used were equivalent mixtures of prilocaine and ropivacaine (Xylonest and Naropin); these were diluted with original Ringer’s solution containing epinephrine (1:1,000,000) in 500-ml bottles. The concentrations of the mixtures varied between 0.3% and 0.06% depending on the requirements of surgery. Routinely available 18- to 30-gauge needles were used. The speed of injection varied between 30 ml and 1500 ml per hour depending on the location, the requirements of surgery, and the needle size. Volumes usually ranged from 2 ml to 1000 ml depending on the concentrations. The maximum dose was approximately 4 mg of prilocaine and 2 mg/kg of ropivacaine, which is the maximum tolerated dose. Regardless of secondary disorders, all patients scheduled for skin and lymph node operations under local anesthesia underwent surgery using this kind of anesthesia, including those for the nose and ear region. No suprarenin was added for nerve blocks of the fingers and penis. This technique was used in 20,310 major and minor skin operations in 11,810 patients ranging in age from 0.5 years (510 children under 14 years) to 95 years (mean age 55 years; 49% females, 51% males), including all types of local flaps and grafts. There were no complications whatsoever from local anesthesia. The technique proved safe and comfortable even for children and very sensitive patients. The median duration of postoperative anesthesia was 4.3 h (maximum 23 h). We found that experience is required for correct selection of the needle position, the flow rate, and the volume.
European Journal of Plastic Surgery – Springer Journals
Published: Feb 1, 2004
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