<p>Successful intralipid-emulsion treatment of local anesthetic systemic toxicity following ultrasound-guided brachial plexus block: case report</p>

Abstract

Background Local anesthetic systemic toxicity (LAST) is a life-threatening complication that may follow application of LAs through various routes. Despite increasing usage of LA techniques in a large number of health-care settings, contemporary awareness of LAST and understanding of its management are inadequate. Case presentation We report two cases who suffered LAST following brachial plexus block for surgery on the upper extremity. The first patient received an ultrasound-guided supraclavicular block with 300 mg lidocaine (6 mg/kg) and 50 mg ropivacaine (1 mg/kg) in 25 mL without epinephrine, and the second patient received an ultrasound guided interscalene block with 200 mg lidocaine (4.5 mg/kg) and 45 mg ropivacaine (1 mg/kg) supplemented with epinephrine 1:200,000. Both patients presented with symptoms of central nervous and respiratory system depression, the first roughly 10 minutes after injection, and the second immediately after withdrawal of the needle. In both cases, thorough recovery was obtained using lipid-emulsion therapy. Conclusion The complication of LAST following ultrasound-guided brachial plexus block could be treated successfully applying the American Society of Regional Anesthesia and Pain Medicineprotocol of intravenous administration of lipid emulsion.

Intravenous Lipid Emulsion for the Treatment of Perioperative Cocaine Intoxication

“…ILE has been recommended for multiple lipid-soluble drugs, including local anesthetics [7]. Our case, along with some reported literature [6], suggests that the systemic effects of cocaine, an old local anesthetic, could potentially be reversed by applying the American Society of Regional Anesthesia and Pain Medicine protocol of intravenous lipid emulsion [8]. Prompt treatment of acute cocaine toxicity is crucial to avoid organ damage.…”

Management of Local Anesthetics Systemic Toxicity In A 78 Year Old Man Undergoing Remove Of Inplate

“…LAST management consists of 3 pillars, namely seizure management, Advanced cardiac life support (ACLS), and administration of 20% lipid emulsion. 10 Oxygen supplementation should be given, but in patients with unstable hemodynamics such as arrhythmias, apnea, or cardiac arrest, invasive airway management should be considered. 9,10 We intubate the patient to control his airway.…”

“…10 Oxygen supplementation should be given, but in patients with unstable hemodynamics such as arrhythmias, apnea, or cardiac arrest, invasive airway management should be considered. 9,10 We intubate the patient to control his airway.…”

“…The main principle of LAST management is to ensure adequate ventilation and organ perfusion with oxygen-rich blood to the brain, heart, and kidneys to prevent acidosis until lipid emulsion therapy. 10 We give him lipid emulsion as stated in the algorithm. The use of lipid emulsion should be started as early as possible by bolus followed by an infusion, and evaluation should be done carefully.…”

“…2 Lipid emulsion has a scavenging effect that can extract LA from plasma. [9][10][11] Prevention of LAST can be done by using guiding ultrasound, doing the injection incrementally, and using a lower volume of LA. 2 In this patient, ultrasound guiding was not done due to the consent of the patient.…”