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Bupivacaine for Tumescent? John Mauriello, MD, FACPh responds!
Last Updated: 6/22/2011
January 12, 2011 - Thanks Dr. Maruiello for sharing your expertise!
I am most appreciative to you, ron, and to dr. mauriello for the very helpful and prompt assistance
i spent many hours online researching this without finding any useful specific information and dr. mauriello provided it succinctly and authoritatively
thanks to all !
Richard Mueller, MD, FACC, FACP, FAHA
January 11, 2011- John Mauriello, MD, FACPh responds!
my opinion bupivacaine (Sensorcaine® Marcaine®) has a
poor profile when it comes to toxicity. Itís the only local anesthetic that
will stop the heart before stopping respiration. As such, I have never used it
for tumescent anesthesia. With a
true lidocaine toxicity mepivacaine (Polocaine® Carbocaine®)
is the local anesthetic of choice. There is no cross sensitivity between the
amide local anesthetics. It can also be used without epinephrine (for patients
who are sensitive to epinephrine) since it is longer acting then lidocaine and
the addition of epinephrine does not significantly prolong anesthesia with mepivacaine. I add 50 ml of 2 %
mepivacaine to a 500 ml bag of NS with 5 ml of 8.4% Sodium
This gives you 555 ml of 0.18% mepivacaine. Donít use more than this bag (555
ml). Remember if there is any doubt, especially in a patient with multiple
allergies, you can always have the patient tested before the procedure
FUNDAMENTALS OF PHLEBOLOGY: VENOUS DISEASE FOR CLINICIANS. 2nd edition. Royal Society of Medicine
Press. pg 125-136.
John Mauriello, MD, FACPh
Vein Center at Batey Cardiovascular
6100 Pointe West Blvd.
Bradenton, FL 34209
|marcaine is bupivacaine. mepicavacaine is another. i have also seen papers on using diphenhydramine for tumescent, with anesthetic effect. preservative free lidocaine is another option, as is intradermal skin testing/test dose for true lido allergy. have just reviewed this extensively. besides the cardiotoxicity of bupivacaine apparently it is physically incompatible with bicarb and should never be mixed, and is very long acting..hae seen general max doses for bupiva and mepiva but those dont necessarily apply to dilute tumescent use (just like tumescent lido dose much higher than for non tumescent infiltration also, the higher doses are when epi is used), so expert input would be welcome...
Submitted by rich mueller - 1/11/2011
January 10, 2011- Dr. Bush responds and requests input from others!
I have not had experience with Bupivicain. Why not use
Marcaine? We would like the input of other MDís who have used other caine
January 10, 2011 - Dr. Mueller would like to know if anyone uses Bupivacaine for Tumescent and if so how do you dose it?
i've been aware of the cold saline tumescent option since the british group published in phlebology in 2006; a great option, but those with rare lido allergy will still need some anesthesia with skin numbing and for phlebectomy. i just purchased some bupivacaine to have on hand for this rare circumstance but cant find any references to dosing for tumescent, even in the liposuction literature. in fact, dr. jeffrey klein, inventor of t.a., advises never to use any local anesthetic other than lidocaine for tumescent due to toxicity (bupivacaine much more cardiotoxic than lidocaine, for example). has anyone used bupivacaine for tumescent and how to dose it? it comes in .25% vials, so just use 1/4 the amount of lidocaine one usually uses in .05% or .1% lidocaine tumescent? many thanks
Richard Mueller, MD, FACC, FACP, FAHA
Richard l. Mueller, Md, FACC, FACP, FAHA
Clinical Assistant Professor of Medicine
Weill Cornell Medical College
Medical Associates of New York / Cardiovascular Diagnostics, pc
Cosmetic Vein Solutions of New York
401 e. 55 Street
New York, NY 10022-4103
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