Ropivacaine-Induced Local Anesthetic Systemic Toxicity after Superior Hypogastric Nerve Block for Pain Control after Uterine Artery Embolization

Pereira, Keith; Salamo, Russell M.; Morel-Ovalle, L.; Patel, Nirav H; Patel, Ritesh

doi:10.1016/j.jvir.2018.03.024

Cited by 9 publications

(4 citation statements)

References 3 publications

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“…Between December 2017 and May 2020, there were a further 36 cases of LAST reported in 34 peer‐reviewed published articles [6–39]. These data indicated 30% of patients were older than 65 y, and 6% were younger than 5 y. Sixty‐one percent of cases occurred in the hospital; 17% in outpatient surgery centres; and 14% in outpatient clinics (e.g.…”

Section: Clinical Presentationmentioning

confidence: 99%

Updates in our understanding of local anaesthetic systemic toxicity: a narrative review

et al. 2021

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Summary Despite advances in clinical practice, local anaesthetic systemic toxicity continues to occur with the therapeutic use of local anaesthesia. Patterns of presentation have evolved over recent years due in part to the increasing use of ultrasound which has been demonstrated to reduce risk. Onset of toxicity is increasingly delayed, a greater proportion of clinical reports are secondary to fascial plane blocks, and cases are increasing where non‐anaesthetist providers are involved. The evolving clinical context presents a challenge for diagnosis and requires education of all physicians, nurses and allied health professionals about these changing patterns and risks. This review discusses: mechanisms; prevention; diagnosis; and treatment of local anaesthetic systemic toxicity. The local anaesthetic and dose used, site of injection and block conduct and technique are all important determinants of local anaesthetic systemic toxicity, as are various patient factors. Risk mitigation is discussed including the care of at‐risk groups, such as: those at the extremes of age; patients with cardiac, hepatic and specific metabolic diseases; and those who are pregnant. Advances in the changing clinical landscape with novel applications and settings for the use of local anaesthesia are also described. Finally, we signpost future directions to potentially improve the management of local anaesthetic systemic toxicity. The utility of local anaesthetics remains unquestionable in clinical practice, and thus maximising the safe and appropriate use of these drugs should translate to improvements in patient care.

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Section: Clinical Presentationmentioning

confidence: 99%

Updates in our understanding of local anaesthetic systemic toxicity: a narrative review

et al. 2021

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“…Although rare, LAST does occur in routine IR practice, 37 and identifying patients at risk may help minimize the risk of LAST. No high-level evidence is available on potential risk factors, but basic pharmacokinetics dictate that patients with lower hepatic clearance, lower circulating protein levels, lower body mass, and coexisting cardiac disease are at an increased risk.…”

Section: Allergy and Systemic Toxicitymentioning

confidence: 99%

Local Anesthesia in Interventional Radiology

Trerotola

2022

Semin intervent Radiol

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Interventional radiology is an evolving field that treats a variety of diseases. Local anesthetics is an important component of pain management during interventional radiologic procedures. It is highly effective and generally safe for routine procedures. However, local anesthetics can be associated with painful initial injection, allergic reactions, and rare but potentially devastating systemic toxicities. Recent evidence has shown that buffered solution and warm local anesthetics may reduce injection discomfort and improve clinical efficacy. Sensible safety practices and prompt recognition/treatment of the systemic toxicity are of paramount importance to provide safe local anesthesia. Interventional radiologists should be familiar with the basic pharmacology, common local anesthetics, optimizing strategies, complications, and management to provide safe and effective local anesthesia for patients.

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“…Although hypogastric nerve block is another effective method to control pain (3031), it is invasive and can cause systemic toxicity (32). Therefore, the risks and benefits should be considered before choosing this option for pain management.…”

Section: Post-procedural Stepsmentioning

confidence: 99%

Uterine Artery Embolization for Leiomyomas and Adenomyosis: A Pictorial Essay Based on Our Experience from 1300 Cases

Kim

2019

Korean J Radiol

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Since its introduction in 1995, uterine artery embolization (UAE) has become an established option for the treatment of leiomyomas. Identification of a leiomyoma using arteriography improves the ability to perform effective UAE. UAE is not contraindicated in a pedunculated subserosal leiomyoma. UAE in a cervical leiomyoma remains a challenging procedure. A leiomyoma with high signal intensity on T2-weighted imaging responds well to UAE, but a malignancy with similar radiological features should not be misdiagnosed as a leiomyoma. Administration of gonadotropin-releasing hormone agonists before UAE is useful in selected patients and is not a contraindication for the procedure. The risk of subsequent re-intervention 5 years after UAE is approximately 10%, which represents an acceptable profile. UAE for adenomyosis is challenging; initial embolization using small particles can achieve better success than that by using larger particles. An intravenous injection of dexamethasone prior to UAE, followed by a patient-controlled analgesia pump and intra-arterial administration of lidocaine after the procedure, are useful techniques to control pain. Dexmedetomidine is an excellent supplemental sedative, showing a fentanyl-sparing effect without causing respiratory depression. UAE for symptomatic leiomyoma is safe and can be an alternative to surgery in most patients with a low risk of re-intervention.

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Ropivacaine-Induced Local Anesthetic Systemic Toxicity after Superior Hypogastric Nerve Block for Pain Control after Uterine Artery Embolization

Cited by 9 publications

References 3 publications

Updates in our understanding of local anaesthetic systemic toxicity: a narrative review

Updates in our understanding of local anaesthetic systemic toxicity: a narrative review

Local Anesthesia in Interventional Radiology

Uterine Artery Embolization for Leiomyomas and Adenomyosis: A Pictorial Essay Based on Our Experience from 1300 Cases

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