Systemic exposure to monoethylglycinexylidide in extensive tumescent liposuction
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Plastic surgery patients frequently request extensive liposuction on approximately 30 % of the total body surface area, which indicates that the total dose of lidocaine used might exceed the recommended level. Our previous study demonstrated that the risk of toxicity is low because the peak lidocaine level is below the toxic threshold (3 μg/mL). However, monoethylglycinexylidide (MEGX), the active metabolite of lidocaine, has not been measured in extensive liposuction operations.
Ten female patients who requested extensive liposuction were enrolled in this study. The targeted areas were divided into two segments and treated in turn for one session. Serum levels of lidocaine and MEGX were taken every 4 h during the first 24 h after the second infiltration.
The peak lidocaine levels (1.94 ± 0.4 μg/mL) were observed after 12–20 h (16.8 ± 2.53 h), whereas the peak MEGX levels (0.67 ± 0.12 μg/mL) were observed after 16–20 h (17.6 ± 2.07 h). The peak concentrations of lidocaine plus MEGX (2.58 ± 0.47 μg/mL) were observed after 17.2 ± 2.4 h.
This study demonstrated that the risk of MEGX toxicity was as low as that of lidocaine toxicity in extensive liposuction operations.
Level of Evidence: Level IV, risk / prognostic study.
KeywordsLiposuction Lidocaine Monoethylglycinexylidide
The authors thank Wei-gang Cao, M.D., Ph.D., Department of Reconstructive and Plastic surgery in Shanghai Ninth Peoples’ Hospital in performing extensive liposuction. The authors thank Li Sun, Ph.D., Department of Pharmacy in Shanghai Renji Hospital in calibrating lidocaine and MEGX measurements in the plasma.
Compliance with ethical standards
All procedures performed in studies involving human participants were in accordance with the ethical standards of the Shanghai Renji hospital and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
The creation of this article was not supported by any outside funds.
Conflict of interest
Gang Wang and Zhen-zhou He declare that they have no conflict of interest.
Patient provided written consent prior their inclusion in this study.