Local anaesthetic systemic toxicity is rare, but it is fastest to treat when the team has prepared for it. Before any block, calculate the maximum safe dose for the patient's weight, and remember that doses from the surgeon's infiltration add to yours. Know where the lipid emulsion is kept and check it is in date.
Inject in small aliquots with intermittent aspiration and watch for early signs: perioral tingling, tinnitus, confusion, or sudden arrhythmia.
- Calculate the maximum safe local anaesthetic dose before starting.
- Count the surgeon's infiltration in the total dose.
- Know where lipid emulsion is stored and that it is in date.
- Inject in small aliquots with aspiration between them.
- Stop at the first neurological or cardiac warning sign.
Why it matters
Most toxicity is preventable by arithmetic done before the block.
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