Local anaesthetic toxicity

Local anaesthetic systemic toxicity (LAST) is rare with fascia iliaca block. Direct intravascular injection can be avoided by direct visualisation. It is important to be aware of the signs and symptoms. These include:

• Oral numbness / paraesthesia
• Disinhibition, restlessness, confusion
• Muscle twitching, tremor
• Hypertension, tachycardia
• Reduced consciousness, hypotension, seizures, arrhythmias

The AAGBI has a clear summary which may be useful to print out and keep in the department.

Management includes stopping the infiltration, resuscitation, control of seizures and intravenous lipid emulsion (intralipid).

You should be aware of the location and availability of intralipid in your department.