**Abstract**

Plastic surgery can be considered an art form, molding and shaping areas of the body to provide enhancement and visual improvements. During this process, anesthesia is a key role player, for both local and general aspects. Proper combinations of local and general anesthesia can provide not only great pain relief and the ability to perform the artwork of plastic surgery, but can also lead to better and faster postoperative recovery of patients. Take a moment to imagine doing our skills without anesthesia, not only would it be barbaric, but also unethical. The method of using fan-shaped anesthesia application will be explored as a technique to improve patient recovery. This, instead of the classic straightforward areal injection application, seems to provide improved anesthetic distribution, penetrates layers better, and offers a swifter and more efficient way of blocking pain receptors. Choosing an appropriate anesthetic from the various ones available today is very important for pain control and postoperative recovery, as well as combining it with other drugs to increase its duration of action. This medley of drug combinations provides patient satisfaction and enhanced recovery.

**Keywords:** fan-shaped, anesthetic distribution, pain control, enhanced recovery

## **1. Introduction**

The history of local anesthesia starts in 1859 with Niemann's isolation of cocaine. The first drug to be used as a local anesthetic was cocaine by Halstead in 1884. Later, in 1903, Braun used epinephrine as a chemical tourniquet. In 1948, Astra starts to use lidocaine in dentistry. Bupivacaine is discovered in 1957, which is a long-lasting local anesthetic we otherwise prefer. There are many articles detailing local infiltration analgesia used in the abdominal wall. This chapter outlines the use of different long-lasting analgesics in different dosages and compares different analgesics and

applications in the rectus sheath, or wounds and nerve blocks. This is the only study that analyzes using this amount of a specific local long-lasting anesthetics (bupivacaine) in all abdominal wall and abdominoplasty wounds. We use general endotracheal anesthesia in abdominoplasty, tumescent infiltration for liposuction in specific dosages, and pure bupivacaine for infiltration of the abdominal wall and wound areas. The underlying reason for this approach is to facilitate easier and faster recovery in patients, and to mobilize patients after surgery in the shortest time possible. Postoperative conditions concerning the abdominal wall and wounds exhibit less pain, quicker mobilization, and activation of patients on the actual day of surgery and patients resume normal activities within a week after surgery. The tumescent solution with local anesthesia provides an analgesic peak after 8–12 h, losing analgesic quality completely after 48 h. With the inclusion of local infiltration analgesia in the rectus abdominis, external oblique muscles, in the inguinal region, and wound area in a section immediately before the closing procedure, wound pains are reduced in the early postoperative setting, but the effect of infiltrated tumescent fluid is not excluded. Our experience in local infiltration analgesia and analysis as well as talking with our patients after each operation provides the evidence that this analgesic infiltration using bupivacaine is useful in reducing pain during the first postoperative days compared to our other patients who in the past did not receive this type of local infiltration analgesia. This is the reason a larger study and more precise analysis should be undertaken as well as more precisely defining the parameters for obtaining scientific evidence that our method is indeed effective.
