Regional Anesthesia and Local Anesthetic-Induced Systemic Toxicity

Central nervous system toxicity following the administration of levobupivacaine for lumbar plexus block: A report of two cases

“…Thus, the incidence of toxicity depends on the type of block and the choice and dose of local anesthetic used. Auroy et al 18 reported a higher incidence (8 per 10,000) of seizures following peripheral nerve block compared with other types of regional anesthesia, whereas Brown et al 15 noted seizure incidence of 8 per 1,000 patients following interscalene and supraclavicular block. In these 2 studies, none of the patients who had seizures following racemic bupivacaine administration progressed to cardiac arrest.…”

“…This resulted in the immediate termination of the skeletal muscle manifestations of the seizure. Although the management of CNS toxicity following local anesthetic administration varies, in the retrospective review by Brown et al, 15 88% of patients received sodium thiopental and 15% received benzodiazepines to control the seizures and approximately 33% of patients were intubated. These patients may not necessarily require intubation, and indeed, in the second case, the anesthesiologists adopted the more conservative approach of only administering a small dose of sodium thiopental.…”

Use of wound infusion catheters for postoperative local anaesthetic administration in cats

“…40 In humans, the reported incidence of LA toxicity after different nerve blocks varied across studies, with estimates ranging from as low as 2.5 cases per 10,000 blockades to as high as 10 cases per 10,000 blockades. [41][42][43] Notably, one study recorded no events in over 12,000 blockades. 44 The incidence of systemic toxicity in veterinary species is not documented, but is probably very low.…”

Updated Retrospective Single‐Center Comparative Analysis of Peripheral Nerve Block Complications Using Landmark Peripheral Nerve Stimulation Versus Ultrasound Guidance as a Primary Means of Nerve Localization

“…Sites reporting on a quality assurance database from Dartmouth University in 2012 noted only 1 occurrence of LAST in more than 12,000 US‐guided regional anesthesia cases . Although that work was not a comparative study, prior estimates of expected LAST in training programs suggested that it would occur in 1 per 1000 to 1 per 2000 cases, so it appeared that the prevalence with US guidance was markedly lower than with older techniques. Indeed, the improvement in the incidence of LAST may be most notable in training facilities: our database reflects blocks provided by supervised trainees in greater than 95% of cases.…”