Background and Aims Local anaesthetic systemic toxicity (LAST) is a rare but potentially fatal complication of regional anaesthesia. LAST affects two major systems, namely neurologic and cardiovascular¹. The number of regional anaesthesia has been increasing and the risk of LAST, despite all the good practices, increases proportionally. Axillary brachial plexus block is reported as the most associated block to LAST events.²

We pretend to increase awareness to this rare but life-threatening entity.

Methods Case report and literature review.

Results A 55-years-old female patient, ASA II, was admitted for left hand ambulatory surgery. It was performed an ultrasound-guided axillary brachial plexus block. The left axillary artery and the branches of median, radial and cubital nerves were identified. Then 200 mg of mepivacaine and 37.5 mg of levobupivacaine were administered through an in-plane technique. Ten minutes later, the patient became agitated, referring general discomfort, blurred vision, perioral numbness and metallic flavour. She became progressively more lethargic and less responsive to stimulus. She became bradycardic and with high blood pression. LAST treatment was immediately started according to our hospital’s protocol. After stabilization, she was admitted to anaesthetic post-care unit for surveillance and treatment of eventual complications. The symptoms progressively disappeared and she was discharged on the day after.

Conclusions Despite ultrasound technique may increase safety compared with landmark block technique, the risk of vascular injection is not completely abolished.³ The anatomical inter-individual differences of brachial plexus vascularization could be the major factor for reported LAST cases after this approach.