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EP173 Local anesthetic systemic toxicity and the assessment of the maximum allowable dose of local anesthetics: results of an international survey
  1. Fréderic Polus1,
  2. Robbert Buck1,
  3. Guy Weinberg2,
  4. Jirka Cops3,
  5. Isabelle Lenders1,
  6. Darren Jacobs3,
  7. Imré Van Herreweghe1 and
  8. Michael Fettiplace4
  1. 1Anesthesia, ZOL Genk, Genk, Belgium
  2. 2Anesthesia, UI Health, Illinois, USA
  3. 3Biomedical sciences, Nysora, Leuven, Belgium
  4. 4Anesthesia, Massachusetts General Hospital, Boston, USA


Background and Aims Calculating local anesthetic (LA) dosing is essential to decrease the risk of Local Anesthetic Systemic Toxicity (LAST). Determining the maximum allowable dose in individual patients is challenging, particularly when nerve blocks are used in combination with intraoperative local infiltration anesthesia (LIA) by surgeons. We polled anesthesia practitioners on their methods to estimate the maximum allowable LA dose and how they factor-in the administration of LA by the surgeon in addition to regional anesthesia.

Methods A survey on the methods to determine the maximum allowable LA dose was sent to 82.820 NYSORA newsletter subscribers. The survey comprised questions on the methods of LA dose calculation, questions on LA mixtures, and questions on ultrasound guidance (Appendix 1).

Abstract EP173 Table 1

Appendix 1

Results Of the 82.820 survey recipients, 461 (0.6%) replied. Over half of the responders (52%) witnessed LAST at least once in their practice. Nevertheless, 26.5% indicated that they do not routinely factor-in additional doses of LIA by surgeons. Forty percent reported that there is insufficient communication with surgeons to estimate the maximum allowable dose of LA, with 71% of responders expressing concern that this may increase the risk of LAST.

Conclusions Over half of the respondents observed LAST at least once, suggesting that the risk of LAST continues to threaten patient safety. Not routinely calculating the maximum dose, including the additional intraoperative LIA by surgeons, may increase the risk for LAST. Developing a tool to determine the maximum allowable dose for multiple LA administrations (i.e., regeneration rate) in individual patients may be beneficial to patient safety.

  • LAST
  • local anesthetic systemic toxicity
  • maximum dose
  • local anesthetics
  • survey

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