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A 6 YEAR RETROSPECTIVE REVIEW OF CASES OF LOCAL ANAESTHETIC SYSTEMIC TOXICITY (LAST) FROM ANAESTHETIC INCIDENT REPORTING SYSTEM OF A SINGLE TERTIARY INSTITUTION
ESRA Academy. Thay Y. Sep 8, 2016; 138215
Topic: SAFETY AND COMPLICATIONS OF REGIONAL ANAESTHESIA (RA)
Disclosure(s): NA
Dr. Yu Jia Thay
Dr. Yu Jia Thay

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Abstract
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Background and Aims:

Local anaesthetic systemic toxicity (LAST) is an important and potentially fatal complication of regional anaesthesia. We wanted to determine the reported cases, management and outcome at our institution. 

Methods:

We performed a retrospective review of cases of LAST from an anonymous hospital anaesthetic incident reporting system over 6 years from 2009 – 2014. 

Results:

There were 4 cases of LAST. 3 occurred after a single injection of LA for peripheral nerve block (PNB), 1 after repeated LA injection by surgeon for local field infiltration anaesthesia. LA used: lignocaine 1% 100mls, lignocaine 1.5% 20mls and bupivacaine 0.5% 20mls given with and without adrenaline 1:200,000, and bupivacaine 0.5% 12mls given before procedure terminated due to cardiovascular collapse. 

3 cases of LAST after PNB (2 combined femoral/sciatic nerve blocks,1 supraclavicular brachial plexus block) included 2 ultrasound guided and 1 landmark/peripheral nerve stimulator. In all cases, intermittent aspiration for blood was confirmed negative before LA injection. 

Initial presentation with seizure (terminated with benzodiazepine) in 1 case, and only CNS excitation manifestations in another. 2 cases presented with cardiovascular toxicity(hypotension, cardiac arrhythmias). Intralipid 20% given in all cases, however varying doses used (73 - 800mls). 2 patients passed away, while other 2 recovered. 

Conclusions:

Presentation of LAST can be very variable - constant vigilance important. Patient factors, drug choice and doses, choice of PNB influences the risk. Intermittent aspiration and ultrasound may mitigate the risk, but is not foolproof. Early recognition, discontinuation of LA, prompt resuscitation(airway, breathing, circulation), seizure termination and use of lipid emulsion therapy is crucial.

 

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