Local Anesthetic Toxicity: Prevention and Management

  • Derek Dillane

Key Points

  • An unintentionally high blood level of local anesthetic results in an excessive concentration at the central nervous and cardiovascular systems. This may lead to a clinical spectrum of toxicity ranging from mild symptoms to cardiac arrest and death.

  • Rate of absorption of local anesthetic into the bloodstream is a primary determinant of systemic toxicity and is influenced by local vascularity and extent of local tissue binding.

  • Presentation and rapidity of onset of local anesthetic toxicity is variable and is dependent on the local anesthetic used and whether the patient is sedated/anesthetized.

  • Intralipid emulsion is effective at reversing local anesthetic toxicity, although the underlying mechanism is poorly understood.

  • CPR, ACLS, and low-dose epinephrine are the focus of treatment for local anesthetic toxicity-induced cardiovascular collapse.

  • Preventative measures (safety checklists, monitoring, appropriate dosing) can help reduce the incidence of local anesthetic toxicity.

  • Evidence from a large multi-center regional anesthesia database reports a reduction in local anesthetic systemic toxicity of 65 % when ultrasound guidance is used compared with peripheral nerve stimulation alone.


Local anesthetic Regional anesthesia Systemic toxicity Cardiac toxicity Intralipid emulsion Ultrasound guidance 


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Copyright information

© Springer International Publishing AG 2017

Authors and Affiliations

  1. 1.Department of Anesthesiology and Pain MedicineUniversity of AlbertaEdmontonCanada

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