Tumescence Infiltration

What is tumescence infiltration anaesthesia?

Tumescent anaesthesia is a commonly employed technique used for infiltration of anaesthetic medication. It is commonly used in dermatologic and cosmetic procedures. This method requires subcutaneous infiltration tumescent fluid in large volumes to  induce numbness, swelling, and firmness of targeted areas. This facilitates the surgical procedure that is to be conducted thereon. The fluid contains lidocaine (0.05% or 0.1%), sterile saline solution, and epinephrine (1:1,000,000). Often, this technique is used together with intravenous sedation. The anaesthetic effects can last up to 18 hours.

When is it indicated?

Tumescent anaesthesia is administered before performing EVTA (Endo-Venous Thermal Ablation). It induces an anaesthetic effect on the affected vein and surrounding tissue. The affected vein, which is to be operated, can be visualised better under guidance of a duplex ultrasound as it is swollen and firm and largely straightened out.

What is the technique of administering this anaesthesia?

  • The procedure involves visualisation of the affected vein (generally, the great saphenous vein) and sapheno-femoral junction.
  • Before giving tumescent anaesthesia, local anaesthesia is administered with a size 25-G needle.
  • Next, the anaesthesia fluid is administered under ultrasound guidance (10–20 ml at each site) using a 21-G needle, following standard procedures.

Tumescence anaesthesia serves three purposes:

  • The vein and surrounding tissue is numb (role of lidocaine)
  • The vein contracts over the fibre and facilitates better contact (role of epinephrine)
  • The fluid excess facilitates dispersion of heat energy and prevents the surrounding tissue from getting burnt while the vein is being ablated (role of saline fluid)

There are many ways to inject tumescent fluid in the peri-venous area:

  • Inject by hand
  • Inject using Pressure bag
  • Inject using Automated Infiltration Pump

Advantages of this technique:

  • The technique is simple to perform
  • It is an alternative to the long spinal needle that is conventionally used
  • The vein to be operated on becomes firm and swollen and somewhat straight, facilitating the laser procedure
  • Can be easily taught to trainee surgeons

Disadvantages of this technique:

  • Multiple sites need to be injected, first for local anaesthesia and then for tumescence anaesthesia.
  • Possibility of lidocaine toxicity needs to be considered since a large amount of anaesthetic medicine will be administered.
SR NO.Method of InflitrationProsCons
1.
  • By Hand
  • Relatively inexpensive
  • Useful only for small quantities of infiltration.
  • Time consuming
  • Labour intensive work
  • Rate of infiltration may slow
2.
  • By a pressure bag
  • More expensive
  • Allows better control over rate of infiltration compared to hand
  • Pressure keeps on decreasing in the pressure bag, need staff to stand and monitor pressure at a high level
  • Cost of pressure bag added to the overall cost
  • Risk related to high pressure to the IV bag
  • More expensive IV bag has to be used
3.
  • By an automatic pump
  • Allows infiltration of large quantities in a very short time
  • Infiltration at a higher pressure compared to the other methods means less needle pricks to the patient
  • Allows better control over the rate and speed of infiltration
  • Overall cost effective
  • One time equipment cost may seem high
  • Expensive than hand injection method
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