Local-anaesthetic systemic toxicity is rare but can be fatal, and it is most survivable when the team recognises it early and the rescue is already to hand. The pearl is to prepare for it before the block, not after symptoms start.
Use the lowest effective dose and stay within weight-based maximums, aspirate before injecting, and give incremental doses while watching for early signs — perioral tingling, metallic taste, agitation, then arrhythmia or seizure. Keep 20% lipid emulsion immediately available wherever large-volume blocks are performed, with the dosing to hand.
At the first sign, stop injecting, call for help, manage the airway and seizures, and start lipid emulsion early alongside standard resuscitation, remembering that resuscitation may be prolonged. A written protocol and a stocked kit turn a crisis into a drill.
- Use the lowest effective local-anaesthetic dose and stay within weight-based maximums.
- Aspirate before injecting and give incremental doses while watching for early toxicity.
- Keep 20% lipid emulsion and its dosing immediately available wherever blocks are done.
- At the first sign, stop, call for help, support airway and circulation, and start lipid emulsion early.
Why it matters
Local-anaesthetic systemic toxicity is survivable when lipid emulsion and a rehearsed response are ready before it happens, not sourced mid-crisis.
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