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Local Anesthetic Systemic Toxicity: A Review of Recent Case Reports and Registries
  1. Marina Gitman, MD* and
  2. Michael J. Barrington, MBBS, FANZCA, PhD
  1. *Department of Anesthesiology, University of Illinois College of Medicine, Chicago, IL
  2. Department of Anaesthesia and Acute Pain Medicine, St Vincent's Hospital Melbourne, Melbourne Medical School, University of Melbourne, Victoria, Australia
  1. Address correspondence to: Marina Gitman, MD, Department of Anesthesiology, College of Medicine, University of Illinois, 1740 W Taylor St, Suite 3200 W, Chicago, IL 60612 (e-mail: gitman{at}


Abstract This review summarizes presenting features, management, and outcomes of local anesthetic systemic toxicity (LAST) from published cases and those submitted to online registries capturing use of intravenous lipid emulsion (ILE) therapy. The results of single-center and multicenter registries and epidemiologic studies complement this information. Between March 2014 and November 2016, 47 separate cases of LAST were described in 35 peer-reviewed articles. Local anesthetic systemic toxicity events occurred as a result of penile blocks (23%), local infiltration (17%), and upper/lower extremity, torso, and neuraxial blockade. Twenty-two patients (47%) were treated with ILE, and 2 patients (4.3%) died. During the same time period, 11 cases submitted to were treated with ILE and survived. The incidence of LAST reported in registries is 0.03% or 0.27 (95% confidence interval, 0.21–0.35) per 1000 peripheral nerve blocks (denominator of 251,325). Seizure (53% and 61% from case reports and registries, respectively) was the most common presenting feature.

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  • The authors declare no conflict of interest.