Local Anaesthetic Systemic Toxicity in a Patient under General Anaesthesia (GA): A Diagnostic Challenge

Prakash, Ravi; Kumar, Sanjeev; Singh, Ritu

doi:10.7860/jcdr/2015/11104.5540

Cited by 2 publications

(3 citation statements)

References 10 publications

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“…5,9,11,17,23,[32][33][34] The remaining cases resulted from neuraxial (13%: 4 of the 6 were epidural, 2 were described specifically as caudal injections), 16,20,26,29,30,38 paravertebral blocks (8.5%), 15,21,22,30 lower (8.5%) 6,7,13 and upper (8.5%) 6,31,36,39 extremity blocks, head and neck blocks (8.5%) (maxillary nerve, peribulbar), 14,19 topical, 28,35,37 transabdominis plane blocks, 8 and intravenous administration. 18 Seven cases (15%) involved continuous infusions of local anesthetic.…”

Section: Block Typesmentioning

confidence: 99%

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Local Anesthetic Systemic Toxicity

Gitman

Barrington

2018

Regional Anesthesia and Pain Medicine

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This review summarizes presenting features, management, and outcomes of local anesthetic systemic toxicity (LAST) from published cases and those submitted to online registries capturing use of intravenous lipid emulsion (ILE) therapy. The results of single-center and multicenter registries and epidemiologic studies complement this information. Between March 2014 and November 2016, 47 separate cases of LAST were described in 35 peer-reviewed articles. Local anesthetic systemic toxicity events occurred as a result of penile blocks (23%), local infiltration (17%), and upper/lower extremity, torso, and neuraxial blockade. Twenty-two patients (47%) were treated with ILE, and 2 patients (4.3%) died. During the same time period, 11 cases submitted to lipidrescue.org were treated with ILE and survived. The incidence of LAST reported in registries is 0.03% or 0.27 (95% confidence interval, 0.21-0.35) per 1000 peripheral nerve blocks (denominator of 251,325). Seizure (53% and 61% from case reports and registries, respectively) was the most common presenting feature.

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Section: Block Typesmentioning

confidence: 99%

“…9,11,13,15,16,19,29,33,34,38 In 2 cases, the presence or absence of an intravascular marker was irrelevant. In 1 case, the local anesthetic was purposefully injected intravenously to blunt the clinical response to tracheal extubation, 18 and in another, the patient self-administered a topical preparation.…”

Section: Vascular Markersmentioning

confidence: 99%

Local Anesthetic Systemic Toxicity

Gitman

Barrington

2018

Regional Anesthesia and Pain Medicine

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“…[ 1 6 10 ] Although a very effective and satisfactory drug, apprehension and deviation away from its use have been seen due to rare but severe toxicity effects related to the cardiac system and CNS. [ 7 15 16 ] Ropivacaine is an amide group LA and is a pure left isomer. [ 7 8 ] It is less lipophilic compared to bupivacaine.…”

Section: Discussionmentioning

confidence: 99%

Comparison of efficacy of epidural ropivacaine versus bupivacaine for postoperative pain relief in total knee replacement surgeries

et al. 2018

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Background:Epidural analgesia has become the standard of care for knee replacement surgeries worldwide. Bupivacaine has been used successfully for many years. Epidural ropivacaine is now being used increasingly and seems to have benefits other than just pain relief, in terms of a better safety profile.Aim:To compare the efficacy of bupivacaine 0.125% (Group B) versus two concentrations of ropivacaine 0.1% (Group R1) and 0.2% (Group R2), in terms of pain scores, requirement of rescue analgesia, related adverse effects, and duration of postoperative (PO) hospital stay.Materials and Methods:A retrospective study was conducted from the acute pain service data of patients who underwent joint replacement surgeries in one or both limbs, over a span of 6 months. Patients were allocated to and analyzed under one of the three groups based on the drug concentration used postoperatively by epidural infusion. Data retrieved were demographic data, daily average visual analog scale (VAS) pain scores, rescue analgesia given, adverse effects, and PO hospital stay days for all three groups.Results:Demographic data were comparable between the three groups. Daily average VAS pain scores on days 1 and 2 were significantly higher in Group R1. Groups B and R2 were comparable. There was significantly more requirement of rescue analgesia in Group R1 on day 1. Day 2 showed no significant difference in rescue analgesic requirement in all three groups. Days of PO hospital stay were significantly higher in Group R1. Adverse effects such as hypotension and delayed motor block were higher in Group B.Conclusion:Ropivacaine 0.2% and bupivacaine 0.125% were equally efficacious in terms of VAS pain scores, rescue analgesic requirement, and duration of PO hospital stay, but ropivacaine had a better safety profile in terms of less hypotension and lesser motor block.

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Local Anaesthetic Systemic Toxicity in a Patient under General Anaesthesia (GA): A Diagnostic Challenge

Cited by 2 publications

References 10 publications

Local Anesthetic Systemic Toxicity

Local Anesthetic Systemic Toxicity

Comparison of efficacy of epidural ropivacaine versus bupivacaine for postoperative pain relief in total knee replacement surgeries

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