Abstract

To analyze the pharmacokinetic interactions between high-volume tumescent local anesthesia (TA) and concurrent antimicrobial therapy in endovenous thermal ablation, and to propose a standardized safety protocol. A narrative review with a systematic literature search was conducted (1993–2026) using MEDLINE, Google Scholar, and Cochrane databases. Studies were selected based on clinical relevance to lidocaine pharmacokinetics, CYP450 enzyme inhibition, and documented adverse events in tumescent anesthesia settings. Three distinct risk categories for antibiotics were identified based on their inhibitory effects on lidocaine clearance. Analysis of case reports revealed that Local Anesthetic Systemic Toxicity (LAST) frequently manifests with delayed onset (8–18 hours post-operatively) in TA. Furthermore, 74% of recent LAST-related fatalities have been attributed to lidocaine, often in outpatient settings where early central nervous system (CNS) prodromes (agitation, trembling) are misidentified as benign sympathomimetic responses to epinephrine. Standardizing a 7–14 day antibiotic washout and integrating a medication-specific "Surgical Timeout" are essential. Clinicians must distinguish the neuro-excitatory signs of toxicity from adrenaline-induced reactions to prevent avoidable cardiovascular collapse.

Key words: Endovenous ablation, lidocaine toxicity, Cytochrome P450, surgical safety, drug interactions