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# TUSQ OD ## Overview TUSQ OD is a fixed-dose combination product containing **tumescent lidocaine** and **bupivacaine**. It is a sterile, non-pyrogenic solution intended for infiltration anesthesia. ## Primary Indications TUSQ OD is indicated for producing local anesthesia in surgical procedures, such as liposuction, where a large volume of anesthetic solution is required for tissue tumescence and anesthesia. ## Adult Dosing The dose varies greatly depending on the procedure, patient size, and desired duration of anesthesia. The total volume administered should not exceed recommended limits to avoid systemic toxicity. Refer to specific surgical protocols for guidance. Generally, it is administered via infiltration into subcutaneous tissue. ## Pediatric Dosing There is no established pediatric dosing for TUSQ OD. Its use in pediatric populations is not recommended. ## Dose Adjustments No dose adjustments are specified. Careful consideration of total dose and maximum allowable doses of lidocaine and bupivacaine should be made, considering patient weight and health status. ## Contraindications * Known hypersensitivity to amide-type local anesthetics, lidocaine, bupivacaine, or any component of the formulation. * Severe shock or heart block. * Infiltration into areas of infection or inflammation. ## Adverse Effects Systemic adverse effects are related to the central nervous system (CNS) and cardiovascular system and are usually associated with high plasma concentrations. * **CNS:** Lightheadedness, dizziness, tinnitus, circumoral numbness, metallic taste, blurred vision, tremors, twitching, convulsions, unconsciousness, respiratory depression, and arrest. * **Cardiovascular:** Hypotension, bradycardia, arrhythmias, cardiovascular depression, and arrest. * **Allergic:** Rare, but can manifest as urticaria, edema, and anaphylactoid reactions. ## Key Drug Interactions * **Opioid Analgesics:** Additive CNS and respiratory depression. * **Benzodiazepines:** May reduce the dose of local anesthetic required and decrease the incidence of CNS side effects. * **Other CNS Depressants:** Increased risk of additive CNS depression. * **Antiarrhythmics (e.g., amiodarone, mexiletine):** Potential for additive cardiac effects. ## Monitoring * Monitor vital signs (heart rate, blood pressure, respiratory rate) closely during and after administration. * Observe for signs of CNS or cardiovascular toxicity. * Monitor for allergic reactions. ## Clinical Pearls * The concentration and volume of TUSQ OD should be tailored to the specific surgical procedure and patient. * The addition of epinephrine may be considered to prolong the duration of action and reduce systemic absorption, but its use in digits, nose, ears, or penis is contraindicated due to risk of ischemia. * Ensure availability of resuscitation equipment and personnel trained in managing adverse reactions to local anesthetics. * Slow injection and aspiration before and during injection can help prevent intravascular administration. *** **Disclaimer:** This information is intended for healthcare professionals. Always consult the official prescribing information and relevant guidelines for the most up-to-date and comprehensive details before prescribing or administering any medication.