Severe local anaesthetic toxicity

Blog Post by Dr Natasha Elworthy FRCA, Specialty Trainee in Anaesthesia, Papworth Hospital NHS Foundation Trust, Cambridge and Dr Stephen T Webb MB BCh BAO FRCA EDIC, Consultant in Anaesthesia & Intensive Care Medicine, Papworth Hospital NHS Foundation Trust, Cambridge

The use of local anaesthetic in hospitals is commonplace and thus management of local anaesthetic toxicity is of paramount importance. Recent cohort studies have established the incidence of severe systemic local anaesthetic toxicity, defined as seizures with or without cardiac arrest, as 1:10,000 following epidural local anaesthesia and 1:1000 following peripheral nerve blockade ₍₁₎.

Until as recently as 2005 there was no widely agreed approach to the management of local anaesthetic toxicity ₍₂₎, local anaesthetic toxicity seeming to be largely resistant to standard Advanced Life Support (ALS) resuscitation efforts. By 2007 there was however an increasing case database of successful cardiac resuscitation from severe local anaesthetic toxicity following the use of intravenous Intralipid 20%, a sterile fat emulsion. The Association of Anaesthetists of Great Britain and Ireland (AAGBI) published the first set of standardised guidelines for severe local anaesthetic toxicity in 2007 _(1,3).