Peripheral nerve blocks are increasingly used.
Peripheral nerve blocks are regional anaesthesia which are
injected near a specific nerve or bundle of nerves to block sensations of pain
from one particular area of the body, which usually last longer than local
anaesthesia. The clinical significance of local anaesthetic systemic toxicity
(LAST) has been well explained in this study, which provided useful results.
Peripheral nerve blocks are increasingly used. However,
despite low complication rates, concerns regarding local anesthetic systemic
toxicity remain. Although recent studies suggest that this severe complication
has decreased considerably, there is a paucity of data about it on a national
level. We sought to elucidate the incidence of local anesthetic systemic
toxicity on a national level and therefore provide guidance toward the need for
preparedness in daily anesthetic practice.
We searched a large administrative
database for patients who received peripheral nerve blocks for total joint
arthroplasties from 2006 to 2014. Their discharge and billing data were
analyzed for International
Classification of Diseases, Ninth Revision, Clinical Modification codes
coding for local anesthetic systemic toxicity or surrogate outcomes including
cardiac arrest, seizures, and use of lipid emulsion on the day of surgery.
Rates for these outcomes were determined cumulatively and over time.
We identified 238,473 patients
who received a peripheral nerve block within the study period. The cumulative
rate of outcomes among these patients in the study period was 0.18%. There was
a significant decrease of overall outcome rates between 2006 and 2014. Use of
lipid emulsion on the day of surgery increased significantly in total knee
replacement from 0.02% 2006 to 0.26% in 2014.
The incidence of local
anesthetic systemic toxicity is low but should be considered clinically
significant. Since it may cause substantial harm to the patient, appropriate
resources and awareness to identify and treat local anesthetic systemic
toxicity should be available wherever regional anesthesia is performed.
Regional Anesthesia and Pain Medicine
Incidence of Local Anesthetic Systemic Toxicity in Orthopedic Patients Receiving Peripheral Nerve Blocks
Mörwald at al.
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