- Design
- Disproportionality analysis of national poison-centre reports, 1983 to 2022
- Population
- Reports of local anaesthetic poisoning and death to the US NPDS
- Primary outcome
- Reports of poisoning and death after vs before the 2010 advisories
- Effect
- All local anaesthetics ROR 0.77 (0.76 to 0.78); lidocaine ROR 2.7 (1.3 to 5.6)
This study analysed reports of local anaesthetic poisoning and death to the US National Poison Data System from 1983 to 2022, comparing the decade after the 2010 society advisories on local anaesthetic systemic toxicity with the decade before.
Reports of local anaesthetic poisoning fell after 2010 relative to all other poisonings (reporting odds ratio 0.77, 95% CI 0.76 to 0.78), driven by fewer non-lidocaine reports. Reports of lidocaine poisoning and death, however, rose (ROR 2.7, 95% CI 1.3 to 5.6). Among reported deaths, the share occurring in the operating room fell from 47% to 15%, while the share linked to intravenous lidocaine rose from 3% to 27%, mostly in emergency settings.
Poison-centre reports are voluntary and incomplete, so these are reporting trends rather than true incidence. The fall coincides with ultrasound-guided blocks and lipid emulsion, but the study cannot attribute it to them.
The practical signal is clear: intravenous lidocaine, used increasingly for analgesia and arrhythmia outside theatre, is where deaths are now being reported. Dosing guidance, cumulative-dose checks and toxicity readiness need to follow it out of the operating room.
- Treat intravenous lidocaine infusions as a toxicity risk wherever they are given.
- Write a maximum cumulative dose on the prescription for any lidocaine infusion.
- Make lipid emulsion and a toxicity protocol available in emergency departments and wards using infusions.
- Report suspected local anaesthetic toxicity, so that trends can be tracked.
- Review local guidance on intravenous lidocaine dosing for analgesia.
Why it matters
Safety efforts built around regional blocks in theatre may be missing where lidocaine now causes reported deaths.
Don't overread it
These are voluntary poison-centre reports; they show reporting trends, not true incidence or cause.
The statistics, in plain English
A reporting odds ratio compares how often an event is reported relative to all other reports; it reflects reporting patterns as well as true risk. The lidocaine estimate of 2.7 has a wide interval, from 1.3 to 5.6, because deaths are few.
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