| Reference |
LAs |
Type of study |
Tissue or cell type and origin |
LA effects on adipose tissue, adipose-derived stem cells and fat grafting |
Comments |
| Moore et al. 1995 (85) |
Lidocaine |
In vitro |
Adipocytes from human suction lipectomy, after collagenase digestion |
Lidocaine potently inhibits glucose transport and lipolysis in adipocytes and their growth in culture
But adipocytes regain their function after washing |
This study introduces the impact of LAs in AFG and proposes washing as an interesting method to erase LA adverse effects |
| Large et al. 1997 (86) |
Lidocaine |
In vitro |
Subcutaneous fat cells from obese patients |
Compared to general anesthesia, local anesthesia does not influence adrenergic regulation of lipolysis |
This study is more related to obesity (adipose tissue harvest during clinical studies) |
| Sommer, Sattler 2000 (11) |
- |
Review |
Comparative studies (human, animal and in vitro studies) on graft survival and longevity |
Review of literature shows similar survival rates of fat grafts after either general or local anesthesia |
This review does not focus on LA effects in AFG and authors draw conclusions from studies that do not focus on the use and effects of LAs |
| Shoshani et al. 2005 (6) |
Lidocaine
Adrenaline |
In vivo (nude mice) |
Adipose tissue from a healthy human patient undergoing elective surgery, and grafted into nude mice |
Lidocaine and adrenaline do not have any influence on the take of fat grafts or adipocyte viability after lipotransfer in nude mice |
This is the first in vivo study related to lidocaine and adrenaline effects
However, this interesting study includes a centrifugation step that may be essential to preserve the cells |
| Keck et al. 2009 (7) |
- Lidocaine 1%
- Articaine 1% + epinephrine 1:200,000
- Ropivacaine 0.75%
- Prilocaine 1%
- Tumescent solution (sodium chloride 0.9% + 25 mL
Articaine 1% + epinephrine 1:200,000 +
25 mL bicarbonate) |
In vitro |
Human preadipocytes in culture (obtained after collagenase digestion of adipose tissue, from abdominoplasties) |
All the tested LAs exert cytotoxic effects
The tumescent solution used (with diluted articaine) appears to be safe |
Incubation time of 30 min is less but very high doses of LAs are directly applied on the isolated cells, which explains the terrible cytotoxic effect |
| Keck et al. 2010 (8) |
- Bupivacaine 1%
- Mepivacaine 1%
- Ropivacaine 0.5%
- Articaine 4% + epinephrine 1:100,000
- Lidocaine 2% |
In vitro |
Human preadipocytes in culture |
All LAs exert cytotoxic effects, to various degrees (articaine + epinephrine is the worst)
All LAs significantly impaired the ability of preadipocytes to differentiate into adipocytes |
Cells have been let in culture for 24 or 48 h before being trypsinized, centrifuged and resuspended directly in the different high concentrated LAs. This explains the high level of cytotoxicity |
| Keck et al. 2012 (87) |
Lidocaine 2% |
In vitro |
Human preadipocytes in culture |
Lidocaine induces necrosis but not apoptosis on preadipocytes. Necrotic effect of lidocaine cannot be prevented by coenzyme Q10. |
The dose of lidocaine used is still very high |
| Sazaki 2011 (88) |
Tumescent lidocaine (10.5 – 20 mg/kg) |
Case report |
Human adipocytes |
The amount of instilled tumescent fluid and lidocaine dosage seem to be safe for water-assisted liposuction |
This study focuses on water-assisted liposuction and does not compare with and without LA |
| Livaoglu et al. 2012 (9) |
Lidocaine + epinephrine
Prilocaine |
In vivo (rat model of AFG with fat from rat) |
Adipose tissue from rat grafted for 30 and 180 days |
Lidocaine plus epinephrine or prilocaine have no negative effect
on microangiogenesis and fat graft survival |
Fat was not from human lipoaspirates but was excised from rats (from inguinal region)
Histologic findings are questionable |
| Girard et al. 2013 (10) |
Lidocaine (0.4 to 1.6 mg/mL)
± adrenaline (1:1000000) |
In vitro |
Human adipose-derived stem cells (ADSCs) in primary culture for few days (4 days without any passage) |
Lidocaine affects ADSC viability (but no apoptosis)
Adrenaline has no effect
Lidocaine cytotoxicity can be partly avoided by washing
Lidocaine may have anti-inflammatory properties |
First authors in vitro study regarding lidocaine effects
In vivo effects have to be confirmed
Clinical doses of lidocaine have been used |
| Girard et al. 2013 (74) |
Lidocaine (0.4 to 1.6 mg/mL)
Ropivacaine (0.4 to 1.6 mg/mL)
± adrenaline (1:1000000) |
In vitro |
Human adipose-derived stem cells (ADSCs) in primary culture for 4 days (no passage) |
Ropivacaine is more cytotoxic than lidocaine |
Ropivacaine and lidocaine have been tested at equal doses, which represent high dose for ropivacaine |
| Girard et al. 2013 (75) |
Tumescent lidocaine (0.8 mg/mL)
+ adrenaline (1:1000000) |
In vivo (mouse model with fat from human patient) |
Adipose tissue from human patient (injected into immunodeficient mice) |
After 1 month of fat grafting, histologic studies reveal that lidocaine infiltrated at the fat harvest site gives worst results compared to tumescent solution without lidocaine
Prior to adipose tissue injection, at least 2 washes with soft and short centrifugations allow to improve graft quality (better organization, more stromal cells) |
This in vivo study completes the previous in vitro studies from authors. Comparison is done from a same patient: adipose tissue was harvested on one side without lidocaine (tumescent adrenaline), and on the other side with a currently used tumescent solution with lidocaine + adrenaline |