Local anaesthetic systemic toxicity can present with perioral tingling, agitation, seizures or sudden cardiovascular collapse, sometimes after a delay. Stop the injection, call for help, secure the airway and treat seizures with a benzodiazepine. Give 20% lipid emulsion as an initial bolus of 1.5 mL/kg over about a minute, followed by an infusion, with repeat boluses if instability persists. During cardiac arrest, continue CPR for longer than usual, as recovery can take time. Every area doing blocks should have lipid emulsion and the guideline immediately to hand.
- Stop injecting at the first signs of toxicity and call for help.
- Give 20% lipid emulsion 1.5 mL/kg as an initial bolus, then start an infusion.
- Treat seizures with a benzodiazepine and support the airway and ventilation.
- Continue resuscitation for longer than usual if cardiac arrest occurs.
- Keep lipid emulsion and the toxicity guideline wherever regional blocks are performed.
Why it matters
Toxicity is rare enough that the dose is often looked up in a crisis, costing time.
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