Tumescent infiltration of lidocaine and adrenaline for burn surgery

Abstract

Tumescent infiltration is a widely used type of regional anaesthesia for cutaneous surgery. This technique makes it possible to administer high doses of lidocaine and adrenaline within the safety limits, leading to reduction in pain and bleeding during the operation. In this study, tumescent infiltration of lidocaine and adrenaline was used in routine procedures of burn surgery such as escharectomy, debridement, tangential excision, and skin grafting. In 17 patients with scald and flame burns, tumescent infiltration was performed prior to surgical procedures under either general anaesthesia or intravenous sedation. After 15 minutes, escharectomy, debridement of necrotic tissues, tangential excision of the burned skin, removal of the granulation tissue, and harvesting of the skin graft were performed. No complications occurred. All vital signs remained within safety limits during the operations. Haemorrhage was minimal and the operations were thus performed easily and rapidly. During removal of granulation tissue, very little blood loss occurred so that both the excision of granulation tissue and skin grafting were accomplished rapidly because of the minimal need of severe haemostasis. The duration of surgery was considerably reduced. No haematoma or bruising developed after surgery. No blood transfusions were required as the decline in haematocrit levels was not more than 3%. Postoperative analgesia was excellent for the first 8 h, eliminating the need of additional measures. Tumescent infiltration of adrenaline and lidocaine is a simple, effective and safe technique which facilitates anaesthesia in large areas of the burned body surface and leads to less bleeding and easy surgical dissection and hydrodissection, allowing fast, easy and painless burn surgery.

Keywords: anaesthesia; burn; lidocaine; sedation; tumescent.

Figures

Fig. 1a. Full-thickness burn eschar, the result of a road accident, during delivery of tumescent solution via a fine cannula. The tumescent solution administered under the necrosis facilitated elevation of the eschar with an action similar to that of hydrodissection.

Fig. 2a. View of lower extremity skin necrosis due to scald burn. Note the significant pallor around the margins of the wound after tumescent infiltration caused by adrenaline’s vasoconstrictor action.

Fig. 3a. View of lower extremity skin defect after excision of the granulation tissue. Note the minimal bleeding from the burn wound and the skin graft donor site.

Fig. 1b. View of wound immediately after excision of eschar. Note the bloodless surgical area, which permitted rapid completion of the operation (less than 10 min).

Fig. 2b. Same wound after debridement of necrotic tissue, showing decreased bleeding and significant pallor of wound surface where epithelium or fibrotic tissue was present.

Fig. 3b. View of wound with skin graft.

Table I. Detailed information about patients, surgery, and medications administered