Tummy tuck anesthesia makes a big difference | Tumescent local vs. General anesthesia

Modified on | by Dr. Ricardo L. Rodriguez

In many plastic surgery forums I always see the question:

Can a tummy tuck can be performed with something other than General anesthesia?

The good news is YES – you can have a tummy tuck with IV Sedation. Instead of general anesthesia, I use local tumescent anesthesia with IV sedation. This type of anesthesia is highly preferable compared to general anesthesia and I want to explain why.

With General anesthesia, a machine is breathing for you and you have a tube down your throat or nose.
With IV anesthesia you are breathing on your own and there is no tube in your throat or nose. Recovery from IV sedation is also much easier than General anesthesia. Most people experience much less nausea with IV sedation.

Tumescent solution to numb the area

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.

Patients have much less nausea with IV anesthesia compared to General anesthesia

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 postoperative period.

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

After tumescent injection to numb area, only IV sedation required

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 light 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.

Tumescent + IV sedation = Less worries than general anasthesia

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, postoperative 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.

By Dr. Ricardo L. Rodriguez MD Board Certified Plastic Surgeon Cosmeticsurg Baltimore, Maryland Ricardo L. Rodriguez on American Society of Plastic Surgeons.

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8 thoughts on “Tummy tuck anesthesia makes a big difference | Tumescent local vs. General anesthesia”

    • Dr. Ricardo L Rodriguez says:

      Clara: I will have Kelly at kelly@cosmeticsurg.net contact you. If you don't hear from her in a few days, contact her directly.

    • Dr. Ricardo L Rodriguez says:

      Diana: Sorry about the delay in responding. We do perform TT in diabetics but a lot depends on how well controlled the diabetes is, if the patient has other associated conditions and general state of health. You should contact your endocrinologist or internist to see if you have low or high surgical risk. I will give Kelly your info and she will contact you. If you do not hear from her, write to her at this email kelly@cosmeticsurg.net Thanks for your interest!

  • Sandy says:

    Hi. I am wondering if you can use the same sedation for breast lift an augmentation so as to avoid blood clots and other risks?

    • Dr. Ricardo L Rodriguez says:

      Sandy: We do ALL our cases with IV sedation, we are very good at it. Avoidance of getting the complications you mention is the main reason we moved to IV sedation and it makes an enormous difference in terms of recovery. The recovery is much shorter, and there is no nausea. Furthermore, because we use pain pumps there is also less need for taking pain medications. Here's Kelly's email address kelly@cosmeticsurg.net. Hope to hear from you soon!!

  • Susan says:

    I have a question regarding tumescent tummy tuck under IV sedation. If I have a tummy tuck under Iv sedation, (but no lipo, or tumescent solution) is it still as safe? i.e. regarding blood clots.....I am assuming that not having general anesthesia reduces the risk for DVT.....is this correct?

    • Dr. Ricardo L Rodriguez says:

      Susan: Not having general anesthesia overwhelmingly decreases the odds of Deep Venous Thombosis (DVT), and its more dangerous sequela, Pulmonary Embolus (PE). THAT is the main reason why I use IV sedation. The risks of general anesthesia, not just DVT and PE, but a whole host of other conditions, rises significantly after 4 hours. All of these complications are avoided with IV sedation. Local anesthetics by themselves can be dangerous in high enough doses. When you do a procedure that covers a large surface area, the amount of local anesthetic needed would be toxic. That is why we use tumescent solution. It is a small dose of local anesthetic, very diluted, and injected over a large surface area. If you let it sit for 20 minutes or so in the area of the body to be operated on, all the nerves eventually get dulled. In combination with a light intravenous hypnotic, it is enough to to a lot of surgery. We can do body lifts, multiple procedures, etc. So, when I do a tummy tuck, I always use tumescent solution, even if I am not going to do lipo. Hope this helps!