2021
DOI: 10.1111/anae.15282
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Updates in our understanding of local anaesthetic systemic toxicity: a narrative review

Abstract: 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 c… Show more

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Cited by 92 publications
(104 citation statements)
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“…Whenever WI is combined with regional anesthesia, it is important to carefully calculate the total safe dose of LA in order to reduce the risk of toxicity. The incidence of local anesthetic systemic toxicity after subcutaneous infiltration is 11%, and other resources discuss more on this topic [55]. It is vital to limit the LA dose based on patient ideal body weight (IBW) [56] and risk factors (age, lower muscle mass, lower ejection fraction, liver and renal insufficiency, and metabolic disorders) [55].…”
Section: Local Anesthetics and Medications For Wound Infiltrationmentioning
confidence: 99%
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“…Whenever WI is combined with regional anesthesia, it is important to carefully calculate the total safe dose of LA in order to reduce the risk of toxicity. The incidence of local anesthetic systemic toxicity after subcutaneous infiltration is 11%, and other resources discuss more on this topic [55]. It is vital to limit the LA dose based on patient ideal body weight (IBW) [56] and risk factors (age, lower muscle mass, lower ejection fraction, liver and renal insufficiency, and metabolic disorders) [55].…”
Section: Local Anesthetics and Medications For Wound Infiltrationmentioning
confidence: 99%
“…The incidence of local anesthetic systemic toxicity after subcutaneous infiltration is 11%, and other resources discuss more on this topic [55]. It is vital to limit the LA dose based on patient ideal body weight (IBW) [56] and risk factors (age, lower muscle mass, lower ejection fraction, liver and renal insufficiency, and metabolic disorders) [55]. Intralipid availability is mandatory for immediate use "at the first signs" of LAST, together with resuscitation equipment and benzodiazepines [37].…”
Section: Local Anesthetics and Medications For Wound Infiltrationmentioning
confidence: 99%
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“…With the strategies such as ultrasound-guided technique, limitation of total drug dose, and co-application of vessel constrictors, the incidence of LAST seems to have decreased to a clinically non-important level, but is by no means unignorable ( Gitman and Barrington, 2018 ) ( Macfarlane et al, 2021 ) In addition, it is now more and more popular to use intravenous local anesthetics for intra-operative analgesia and chronic pain control ( Vanstone and Rockett, 2016 ; Weibel et al, 2016 ; Song et al, 2017 ; Farahmand et al, 2018 ; Soto et al, 2018 ; Clivio et al, 2019 ), however, it may increase the incidence of LAST, because plasm drug concentration would increase more rapidly than local application ( Gitman et al, 2019 ; Torp and Simon, 2020 ). A fundamental method to increase the safety of local anesthetics is to ensure that even if all drugs applied are accidentally injected into the circulation system, there could be a margin wide enough from the actual plasma concentration to the concentration responsible for the earliest toxicities.…”
Section: Discussionmentioning
confidence: 99%
“…In addition, as recently proposed, adoption of institutional guidelines regarding administration, monitoring, detection and treatment of systemic toxicity appears prudent wherever i.v. lidocaine is administered, and training of all involved staff should be mandatory ( 178 ). Perhaps, as recently suggested by Pandit and McGuire, use of intravenous lidocaine is currently best confined to subjects participating in clinical trials (including VAPOR-C) under rigorous safety conditions and where the results of usage can contribute to establishing definitive evidence of clinical benefits or otherwise ( 179 ).…”
Section: Licencing and Safety Concernsmentioning
confidence: 99%