Management of severe local anaesthetic toxicity | Association of Anaesthetists

Management of severe local anaesthetic toxicity 2023

The Association's 2010 laminate for management of local anaesthetic toxicity has been withdrawn.

Since 2010, there have been some subtle changes to the recommended management of local anaesthetic toxicity. Additionally, during that time, the Association has published its Quick Reference Handbook, which includes the most up to date treatment regime. The QRH version has therefore become the reference version.

Therefore, we now recommend that the relevant page (3-10) from the latest version of the Association's Quick Reference Handbook should be kept in the local anaesthetic toxicity treatment box along with relevant drugs and equipment. The principal changes are to signal need for reduced adrenaline dosage and avoidance of vasopressin in LA toxicity, and slower administration of initial bolus of intralipid plus minor wording and formatting changes to aid clarity.

The 2010 version should no longer be used.

If further information is required about local anaesthetic toxicity and its treatment, we recommend this recent review of the topic.

The Resuscitation Council UK (RCUK) have launched their own guideline and supporting article. Their guideline is aligned with the QRH, so anaesthetists can use either.