Today I’m doing an extended abdominoplasty. Instead of general anesthesia, I use local anesthesia with IV sedation. This type of anesthesia is highly preferable compared to general anesthesia and I want to explain why.

Before the surgery even starts I first prep the patient with ‘tumescent solution’. The tumescent solution numbs the area that I perform surgery on. I first inject the area so that it becomes full of fluid. The fluid is a saline solution with very small amounts of anesthetic and vasoconstrictors (to make blood vessels shrink). Once I have injected, I wait a good thirty minutes before I start the actual operation. This gives time for the solution to really absorb into the tissues. The entire local area will become numb and allow me to perform the surgery without the patient feeling anything.

By the time I start the actual surgery, the abdominoplasty, the tissues will be really numb and there will be very minimal blood loss. The numbness will last approximately 12 to 18 hours. The fluid that does not get liposuctioned will stay within the tissues, ready to be absorbed slowly over the next few days as the body needs it. This is important because after surgery, the body will need fluids to recover, but the patient may or may not feel like drinking a lot of fluids.

In the past I used general anesthesia instead of the method I am describing now. I used to send patients home with an IV setup. That was not only uncomfortable for the patient, but they really needed a nurse to monitor the IV. In a lot of cases the patient was nauseated because of pain meds and unable to drink or eat for a few hours. With general anesthesia, it was not unusual for me to have to admit those patients overnight to the hospital. The general anesthesia just added a higher level of complexity to the post operative period.

Tumescent solution used as a local solution with IV sedation has eliminated that extra level of complexity.

So, as I sit here waiting for the tumescent solution to fully absorb, so that I can begin the surgery, the anesthesiologist is slowly letting the patient drift to a gentle sleep where she does not feel anything (because of the tumescent solution), or remember anything because of amnesic medications (thru an IV). The patient does not feel anything but is in a twilight sleep and fully breathing on her own. It is much easier for the patient to ‘wake up’ following surgery compared to general anesthesia as it is a more natural process.

With tumescent anesthesia and IV sedation I do not have to worry about the the many factors that are present with general anesthesia: length of the surgery, post operative nausea and pain, the need for IV and nurses, and possibility of blood clots to leg veins are just not there. So, as I wait to perform this surgery, I can write a blog to tell you what a blessing tumescent solution has been for my patients.

Ricardo L Rodriguez, MD