Comparative evaluation about the efficacy of the use of variable concentrations of Epinephrine in Tumescent solution for control of bleeding in patients with abdominal liposuction
AbstractObjectives: The use of epinephrine for controlling the blood loss has gained out in many dermatological surgeries; however, its use in liposuction has not been studied. In this regard, we aimed to figure out the effectiveness of using epinephrine in tumescent solution during liposuctions surgery.
Methods: In this study we present a prospective, double-blind, nonrandomized study evaluating the effects of adding epinephrine to tumescent solution intra-operative in patients undergoing liposuction. Thirty-six patients including 6 males and 29 females undergoing liposuction were divided into two groups. In case group we use 1-1.4 mg/L epinephrine (based on the location of surgery) in tumescent solution; and control group did not receive epinephrine. Lab data such as hemoglobin and hematocrit as well as clinical data including blood pressure and heart rate were recorded before, after 1h and 6h of liposuction.
Results: In this study, we observed that both case and control group faced a significant dropped in their hemoglobin and hematocrit; however, the decrement was significant lower in case group. In addition, both groups had a stable hemostasis after 1h and 6h of surgery. In this regard, we did not observe any significant difference between heart rate and blood pressure of two groups.
Conclusion: The results of this study suggest that using epinephrine as vasoconstriction agent in tumescent solution might decrease the rate of bleeding and increase the chance of stable hemostasis both during and after abdominal liposuction.
2. Koay J, Orengo I. Application of local anesthetics in dermatologic surgery. Dermatol Surg 2002;28:143-8.
3. Fink BR, Aasheim GM, Levy BA. Neural phar-macokinetics of epinephrine. Anesthesiology 1978;48:263-6.
4. Dunlevy TM, O’Malley TP, Postma GN. Op-timal concentration of epinephrine for vaso-constriction in neck surgery. Laryngoscope 1996;106:1412-4.
5. Pallasch TJ. Vasoconstrictors and the heart. J Calif Dent Assoc 1998;26:668-76.
6. Brown RS, Rhodus NL. Epinephrine and local anesthesia revisited. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2005;100:401-8.
7. Milam SB, Giovannitti JA Jr. Local anesthe-tics in dental practice. Dent Clin North Am 1984;28:493-508.
8. O’Malley TP, Postma GN, Holtel M, Girod DA. Effect of local epinephrine on cutaneous blood ﬂow in the human neck. Laryngoscope 1995;105:140-3.
9. Santos CF, Modena KC, Giglio FP, Sakai VT, Calvo AM, Colombini BL, et al. Epinephrine concentration (1:100,000 or 1:200,000) does not affect the clinical efﬁcacy of 4% articaine for lower third molar removal: a double-blind, randomized, crossover study. J Oral Maxillo-fac Surg 2007;65:2445-52.
10. Sisk AL. Comparison of etidocaine and lido-caine for control of intra- and post-operative bleeding and pain. J Oral Maxillofac Surg 1986;44:16-20.
11. Agresti A. Categorical Data Analysis. 2nd ed. Boston: John Wiley & Sons, 2002.
12. Guinard JP, Carpenter RL, Morell RC. Effect of local anesthetic concentration on capil-lary blood ﬂow in human skin. Reg Anesth 1992;17:317-21.
13. Cansanção AL, Cansanção AJ, Cansanção BP, Vidigal RA. Lipoabdominoplasty in obese patients: Is it safe? Has good results? Plast Reconstr Surg. 2015;136(Suppl):93–94.
14. Rajesparan K, Biant LC, Ahmad M, Field RE. The effect of an intravenous bolus of tranexamic acid on blood loss in total hip replacement. J Bone Joint Surg Br. 2009;91:776–783.
15. Amer KM, Rehman S, Amer K, Haydel C. Efficacy and safety of tranexamic acid in orthopaedic fracture surgery: A meta-analysis and systematic literature review. J Orthop Trauma 2017;31:520–525.
16. Horrow JC, Hlavacek J, Strong MD, et al. Prophylactic tranexamic acid decreases bleeding after cardiac operations. J Thorac Cardiovasc Surg. 1990;99:70–74.
17. Gai MY, Wu LF, Su QF, Tatsumoto K. Clinical observation of blood loss reduced by tranexamic acid during and after cae-sarian section: A multi-center, randomized trial. Eur J Obstet Gynecol Reprod Biol. 2004;112:154–157.
18. Tang YM, Chapman TW, Brooks P. Use of tranexamic acid to reduce bleeding in burns surgery. J Plast Reconstr Aesthet Surg. 2012;65:684–686.
19. Murphy GR, Glass GE, Jain A. The efficacy and safety of tranexamic acid in cranio-maxillofacial and plastic surgery. J Craniofac Surg. 2016;27:374–379.
20. Nair AS, Sriprakash K, Nirale AM, et al. Large volume lipo-suction: Perioperative considerations. Int J Sci Res Publications 2013;3:1–4.
21. Nair AS, Verma S. Use of tranexamic acid in megaliposuc-tion. Int J Pharm Pharm Sci. 2015;7:8.
22. Ors S, Ozkose M. Late postoperative massive bleeding in septorhinoplasty: A prospective study. Plast Surg (Oakv.) 2016;24:96–98.
23. Butz DR, Geldner PD. The use of tranexamic acid in rhytid-ectomy patients. Plast Reconstr Surg Glob Open 2016;4:e716.
24. Ausen K, Fossmark R, Spigset O, Pleym H. Randomized clini-cal trial of topical tranexamic acid after reduction mammo-plasty. Br J Surg. 2015;102:1348–1353.