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LA Overdose Recognition — FRCA Final MCQ

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ModerateRegional AnaesthesiaLA Overdose RecognitionFRCA Final

A 50-year-old woman (ASA II) is undergoing total abdominal hysterectomy. She receives bilateral TAP blocks with 40 mL of 0.25% bupivacaine (100 mg total). The surgeon also infiltrates the wound with 20 mL of 0.5% bupivacaine (100 mg). Total bupivacaine dose is 200 mg. Patient weight is 65 kg. Maximum dose without adrenaline is 2 mg/kg = 130 mg. What should happen now?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: C — Recognise this is a significant overdose (200 mg vs max 130 mg) and monitor closely for LAST for the next 60 minutes

The total bupivacaine dose of 200 mg significantly exceeds the maximum recommended dose of 2 mg/kg (130 mg) without adrenaline. This is a common scenario when multiple practitioners administer LA to the same patient without coordinating total dose. The patient should be closely monitored for signs of LAST (perioral tingling, metallic taste, tinnitus → seizures → cardiovascular collapse) for at least 60 minutes (peak plasma levels from TAP blocks occur at 30-60 minutes). Intralipid should be immediately available. This incident should be reported as a clinical incident.

Reference: AAGBI – 2020 – Management of severe LAST; RCOA – 2023 – Regional anaesthesia safety