Local Anesthetic Systemic Toxicity (LAST): Designing an Educational Effort for Nurses That Will Last

Perioperative Peripheral Nerve Block Safety Education: A Quality Improvement Project

“…The pretest and post-test were the same tests and consisted of six questions 22 (Table 1). The first five questions assessed the knowledge level of the perioperative staff.…”

Is local anesthetic systemic toxicity a concern?

“…Threshold LA blood levels can be exceeded due to unintentional direct arterial or venous injection or slow systemic absorption of a large volume of extravascular LA. 5 The route of LA administration impacts the risk of developing LAST. Highly vascularized sites, such as with intercostal blocks, can increase the risk of direct intravascular injection and systemic absorption.…”

“…Highly vascularized sites, such as with intercostal blocks, can increase the risk of direct intravascular injection and systemic absorption. 5,6 LA doses should be decreased in newborns under age 4 months as protein binding is reduced, which results in increased LA plasma levels. 2 Older adults are at an increased risk of LAST because of age-related peripheral nervous system changes, which lead to increased sensitivity to LAs.…”

“…Toxicity can present at any time, within a minute to an hour of administration and even later. 5 Toxicity presents as abnormalities relating to the CNS and cardiovascular system. Typical signs and symptoms of CNS toxicity include altered mental status, severe agitation, lightheadedness, circumoral numbness, visual or auditory disturbances, seizures, and coma.…”

“…Noticing this pattern is difficult because excitatory signs and symptoms can be masked by sedation or general anesthesia. 5 Signs and symptoms of CV toxicity include hypotension, bradydysrhythmias, conduction defects, ventricular dysrhythmias, and cardiac arrest. The cardiotoxicity of bupivacaine is unique in that the ratio of the dose required for irreversible CC and the dose that will produce CNS toxicity is lower for bupivacaine than other agents.…”